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Nutcracker Syndrome

  • Ajay Savlania
  • Shivanesan Pitchai
Chapter

Abstract

Left renal vein (LRV) compression between the superior mesenteric artery (SMA) and abdominal aorta is referred to as the nutcracker phenomenon (NCP) or LRV entrapment and was first described by anatomist Grant in 1937 [1]. Abdominal aorta and superior mesenteric artery (SMA) act as two arms of a ‘nutcracker’ that can potentially compress the left renal vein [2]. The term nutcracker syndrome (NCS) is the clinical presentation of this phenomenon which is assigned to those patients who present with signs or symptoms of left renal venous congestion and have the anatomical LRV compression [3]. De Schepper, a Belgian physician named this phenomenon as ‘nutcracker syndrome’ [4]. Anatomically classical anterior nutcracker syndrome, in which there is compression of distal LRV between aorta and proximal SMA, is analogous to superior mesenteric artery syndrome (Wilkie’s syndrome) wherein the third part of duodenum gets compressed anteriorly by SMA and posteriorly by aorta [5–10]. The retroaortic or circumaortic renal vein may get compressed between the aorta and the vertebral body causing symptom which is called posterior nutcracker syndrome [11]. NCP on the right side, due to compression of large veins by the gravid uterus, has been also reported [12].

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Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Ajay Savlania
    • 1
  • Shivanesan Pitchai
    • 2
  1. 1.Postgraduate Institute of Medical Education and ResearchTrivandrumIndia
  2. 2.Sree Chitra Tirunal Institute for Medical Sciences and TechnologyTrivandrumIndia

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