Twenty-year analysis of the rarely diagnosed nutcracker syndrome

Year 2022, , 359 - 365, 26.12.2022

Burak Demirci , Çilem Çaltılı , Mehmet Oktay Alkan , İsa Başpınar , Burak Akın , Abuzer Coşkun

https://doi.org/10.47582/jompac.1214930

Abstract

Aim: Nutcracker syndrome is a very rare cause in patients presenting to the emergency department with abdominal pain. Early consideration in differential diagnosis will reduce the time spent for diagnosis and morbidity, as well as provide the correct treatment. We aimed to contribute to the literature by determining the clinical relations of these cases with laboratory, imaging and treatment data.
Material and Method: Twenty-seven patients over the age of 16 who presented to the emergency department with abdominal pain between January 2000 and December 2020 were included in this study. The ages of the patients were between 16-39 and the mean was 25.19±7.00 years. Demographic characteristics, clinical findings, laboratory parameters, radiological evaluations, and treatment modalities of patients were evaluated retrospectively.
Results: Abdominal pain and flank pain were the most common reasons for admission to the emergency department of 27 patients included in the study. In the anterior group, 17 (77%) patients had flank pain, 10 (45%) patients had dysmenorrhea, 11 (50%) hematuria, 10 (45%) proteinuria, and 9 (40%) patients hematuria and proteinuria. In the posterior group, there was no hematuria, proteinuria, anorexia, nausea and vomiting, and oral intolerance. In cases with anteior nutcracker syndrome, 12 (54%) doppler ultrasonography, 13 (59%) computed tomography, 5 (22%) magnetic resonance imaging were performed. Conservative treatment was applied to 11 (40%) patients in the anterior group and 3 (11%) patients in the posterior group. Endovascular surgery was performed on 5 (22%) female patients.
Conclusion: Nutcracker syndrome should be investigated in adult patients who present to the emergency department with abdominal pain and whose diagnosis is unclear. Early diagnosis is critical in terms of treatment and morbidity.

Keywords

Emergency department, abdominal pain, nutcracker syndrome, hematuria, proteinuria

Supporting Institution

None

Nadir görülen nutcracker sendromunun yirmi yıllık analizi

Abstract

Amaç: Acil servise karın ağrısı ile başvuran hastalarda Nutcracker Sendromu çok nadir ortaya çıkan bir nedendir. Ayırıcı tanıda erken dönemde akla getirilmesi, hastanın tanı için geçirdiği süreyi ve morbiditeyi azaltacağı gibi, doğru tedaviyi uygulamayı da sağlayacaktır. Literatür eşliğinde bu olguların değerlendirilmesi amaçlandı.
Gereç ve Yöntem: Bu çalışmaya, Ocak 2000-Aralık 2020 tarihleri arasında acil servise karın ağrısı nedeniyle başvuran 16 yaşından büyük 27 hasta dahil edildi. Hastaların yaşları 16 ile 39 arasındaydı ve ortalaması 25.19±7.00 yıldı. Bu hastaların demografik özellikleri, klinik bulguları, laboratuar parametreleri, radyolojik değerlendirmeleri ve tedavi şekilleri retrospektif olarak değerlendirildi.
Bulgular: Çalışmaya dahil edilen 27 olgunun acil servise en sık başvuru nedeni karın ağrısı ve yan ağrısıydı. Anterior grupta 17 (%77) hastada yan ağrısı, 10 (%45) hastada dismenore mevcutken, 11 (%50) hematüri, 10 (%45) proteinüri ve 9 (%40) hematüri ve proteinüri olgusu vardı. Posterior grupta hematüri, proteinüri, iştahsızlık, bulantı ve kusma ve oral intolerans yoktu. Anterior Nutcracker Sendromu grubunda 12 (%54) Doppler ultrasonografi, 13 (%59) bilgisayarlı tomografi, 5 (%22) manyetik rezonans görüntüleme yapıldı. Anterior grupta 11 (%40) hastaya, posterior grupta 3 (%11) hastaya konservatif tedavi uygulandı. 5 (%22) kadın hastaya endovasküler cerrahi uygulandı.
Sonuç: Erişkin dönemde acil servise karın ağrısıyla başvurun ve tanısı geciken olgularda Nutcracker sendromu düşünülmelidir. Erken tanı değerlendirmesi; tedavi ve morbidite açısından önem taşımaktadır.

Keywords

Acil servis, karın ağrısı, nutcracker sendromu, hematüri, proteinüri

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