Synonym(s)
Nutcracker Syndrome
HistoryThis section has been translated automatically.
Richet, 1857
DefinitionThis section has been translated automatically.
Chronic pelvic pain in women of reproductive age who have had multiple births due to chronic venous congestion. Additionally often dysmenorrhea, cohabitation problems. S.a.u. Pudenda varicosis.
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EtiopathogenesisThis section has been translated automatically.
Multifactorial. Vulvar varices, insufficiency of the ovarian vein (often with connection to leg veins with varices on the medial and posterior side of the thigh), insufficiency of the internal iliac vein and its tributaries, blockage of the venous return of the left renal vein due to its compression between the aorta and the supra-mesenteric vein ("nutcracker syndrome") are described. The consequence is a venous renal congestion with hematuria and pain in the left flank.
ManifestationThis section has been translated automatically.
Occurs in women of childbearing age; peak frequency between the 26-30th year of life.
Clinical featuresThis section has been translated automatically.
Pain syndrome, depending on the severity of the disease:
- Slight symptoms: vulvar varices with 1-3 mm diameter, slight blood reflux from the pelvic veins.
- Moderate symptoms: Vulvar varices 3-5 mm in diameter, dilated ovaries 6-9 mm in diameter, marked blood reflux in the pelvic veins.
- Severe symptoms: vulvar varices > 5 mm diameter, very painful, dilated varicose veins > 9 mm diameter.
- "Nutcracker syndrome": in addition to pelvic vein congestion haematuria, pain in the left flank.
DiagnosisThis section has been translated automatically.
Anamnesis, physical examination, Doppler sonography, colour duplex sonography (abdominal and transvaginal), laparascopy, e.g. gynaecological-oncological causes Angiography: mostly retrograde, selective gonado-iliac phlebography.
TherapyThis section has been translated automatically.
Depending on the clinical findings. Sclerotherapy of the vulvar varices with aethoxysclerol (foam or liquid). Pelvic veins leading to reflux can be approached with embolization or surgically. S.u. Foam sclerotherapy.
LiteratureThis section has been translated automatically.
- Richet NA (1857) Traite practique d'anatomie medico-chirurgiale. E Chamerot Libraire, editor (Paris)
- Scultetus AH et al (2003) The female pelvic vein syndrome - an overview. Phlebology 2: 37-44
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Nutcracker syndrome;Disclaimer
Please ask your physician for a reliable diagnosis. This website is only meant as a reference.
Prof. Dr. med. Peter Altmeyer