Circumaortic Left Renal Vein Causing Combined Nutcracker Syndrome: A Case Report and Literature Review.

Background: Nutcracker syndrome is a rare clinical condition characterised by the compression of the left renal vein (LRV). This syndrome results in venous hypertension and a variety of symptoms, including haematuria and abdominal pain. We reported an unusual case of combined nutcracker syndrome caused by the compression of both branches of a circumaortic LRV, an anatomical variant.

Methods: An 18-year-old female presented with chronic abdominal pain and intermittent haematuria. Laboratory tests and imaging studies including contrast-enhanced computed tomography (CT) of the abdomen and pelvis were performed to investigate the cause. A comprehensive literature review of similar cases was conducted using PubMed.

Results: CT showed circumaortic LRV with the anterior branch compressed between the superior mesenteric artery and the aorta, and the posterior branch compressed between the aorta and the spine. This finding confirmed the diagnosis of combined nutcracker syndrome. The patient opted for conservative management, which improved her symptoms. Literature review identified only five other cases of combined nutcracker syndrome owing to circumaortic LRV.

Conclusions: Combined nutcracker syndrome is primarily diagnosed through imaging and should be considered in patients with chronic abdominal pain and haematuria, especially when anatomic variants such as circumaortic LRV are present. CT allows accurate visualisation of venous compression and the anatomic structures involved.