Recurrent Varicocele Revealing Coexisting Renal Nutcracker and Superior Mesenteric Artery Syndromes: A Case Report
Keywords:
aortomesenteric angle, Superior mesenteric artery syndrome, Nutcracker syndrome, Nutcracker phenomenon, VaricoceleAbstract
Renal nutcracker syndrome (RNCS) is seen when the renal vein is compressed or trapped between the superior mesenteric artery (SMA) and the aorta. Typically, it presents as pain in the left flank and pelvis, along with hematuria, and less commonly as varicocele. Conversely, RNCS is a frequent finding in patients presenting with a varicocele. Superior mesenteric artery (SMA) syndrome is a result of compression of the third part of the duodenum as it passes between the superior mesenteric artery and the aorta. It is one of the rare causes of intestinal obstruction. The coexistence of SMA syndrome and RNCS is uncommon.
A 22-year-old male presented with a long-standing history of abdominal pain, weight loss, and diarrhea for which he had been treated as irritable bowel syndrome. Additionally, the patient underwent surgery for a varicocele a few years ago and now presented with recurrence. Initial laboratory investigations were unremarkable. Scrotal ultrasound scan demonstrated left-sided varicocele. Contrast-enhanced CT of the abdomen revealed findings consistent with RNCS & SMA syndrome. The patient was planned for a second surgery for varicocele and was managed conservatively for RNCS & SMA syndrome.
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Data Availability Statement
The data supporting the findings of this study are available within the article. Additional data are not publicly available due to patient confidentiality.
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Copyright (c) 2026 Asad Ahmad Qureshi, Zoha Maryam (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
