A Rare Condition in Repeat Varicocele; Nutcracker Syndrome

Abstract

ABS TRACTThis case report describes a rare occurrence of Nutcracker syndrome (NCS) in a 21-year-old male with recurrent varicocele. NCS is caused by compression of the left renal vein (LRV) between the aorta and the superior mesenteric artery, leading to venous h ypertension and a variety of symptoms, including testicular pain, hematuria, and pelvic congestion. The patient initially presented with left testicular pain and grade 3 varicocele, which persisted after varicocelectomy. Further diagnostic imaging with contrast-enhanced computed tomography reve aled com- pression of the LRV, confirming NCS. Management of NCS depends on symptom severity, with conservative treatment preferred for mild cases and surgery considered for severe cases. In this instance, the patient was referred for further follow-up with cardiovascular surgery. NCS is a rare but significant cause of recurrent varicocele and should be considered in patients with unresolved or recurring symptoms aftervaricocele surgery.