In Situ Gonadal Vein Valvulotomy and Side-to-side Gonado-iliac Bypass for the Management of Nutcracker Syndrome in an Adolescent With a Solitary Kidney and Absence of Pelvic Congestion

Abstract

Herein we present the first case report of laparoscopic exploration, endovascular valvulotomy, and open side-to-side bypass of a gonadal vein into the ipsilateral external iliac vein for Nutcracker syndrome in an adolescent patient with solitary kidney without pelvic congestion. Though prior management has included various large open surgeries or endovascular or extravascular approaches with the use of stents and shields, this case offers an expanded novel approach to weigh the unique challenges of the patient's age and solitary renal status. If reproducible, this technique may gain value in the management of patients with this rare, incapacitating condition.