Nutcracker Syndrome as an Unusual Cause of Postprandial Pain

Vasc Endovascular Surg. 2020 Apr;54(3):283-285. doi: 10.1177/1538574419896721. Epub 2019 Dec 30.


Nutcracker syndrome is a rare entity in which compression of the left renal vein (LRV), usually by the overlying superior mesenteric artery (SMA), results in renal venous congestion and reflux in the left ovarian vein (LOV). Patients may present with hematuria, left flank pain, dyspareunia, and vaginal or abdominal wall varicose veins. We report a patient with nutcracker syndrome who presented atypically with left flank pain that was exacerbated in the postprandial state. We hypothesize that the physiologic dilation of the SMA after oral intake caused increased LRV compression at that site and augmented lateral LRV distention. The patient had no evidence of SMA syndrome or chronic mesenteric insufficiency. Her symptoms resolved after we performed an LOV to inferior vena cava transposition.

Keywords: SMA syndrome; nutcracker syndrome; ovarian vein transposition.

Publication types

  • Case Reports

MeSH terms

  • Female
  • Flank Pain / diagnosis
  • Flank Pain / etiology*
  • Humans
  • Mesenteric Artery, Superior / diagnostic imaging
  • Mesenteric Artery, Superior / physiopathology*
  • Middle Aged
  • Ovary / blood supply*
  • Postprandial Period*
  • Renal Nutcracker Syndrome / complications*
  • Renal Nutcracker Syndrome / diagnostic imaging
  • Renal Nutcracker Syndrome / surgery
  • Renal Veins / diagnostic imaging
  • Renal Veins / physiopathology*
  • Treatment Outcome
  • Vascular Grafting / methods
  • Vasodilation*
  • Vena Cava, Inferior / surgery