A unique case report of wilkie syndrome in a middle-aged female with posterior nutcracker syndrome.

Abstract

Nutcracker syndrome and Wilkie syndrome are rare and often diagnosed incidentally during imaging investigations for other conditions and, on occasion, together. In this paper, we present the case of a 36-year-old patient with quasi-permanent symptoms including epigastralgia, loss of appetite, early satiety, left lumbar colic pain, normal stool and dysuria. The clinical examination revealed a non-distended abdomen, sensitivity to palpation in the epigastrium and hypogastrium regions, frequent urination in small amounts, and a body mass index (BMI) of 15 kg/m2, indicating severe protein calorie malnutrition. Laboratory tests indicated persistent microscopic hematuria without proteinuria with repeated urinary infections. Abdominal-pelvic ultrasound with Doppler revealed a left renal vein dilated up to 10 mm in the left paraaortic region (Nutcracker syndrome) and distal duodenal obstruction with distension in the same region, which was also confirmed by gastroduodenoscopy (Wilkie syndrome). Abdominal‒pelvic computed tomography angiography revealed a malformed and dilated left renal vein that was compressed as a result of aorto-mesenteric obstruction and communicating with an aberrant left paravertebral and paraspinal network extending to L1 and L5 and thrombosis of the left ovarian vein. The patient benefitted from conservative treatment, which intended to correct the malabsorption syndrome with the help of a nutritionist, who suggested a personalized diet to help gain weight. As a result, the patient was able to avoid surgical treatment. The case is peculiar in that the patient presented with a very rare form of Nutcracker syndrome (posterior type) associated with another rare syndrome, Wilkie syndrome.