ナットクラッカー現象による水腎症の左腎静脈転位手術

A case of left hydronephrosis caused by a nutcracker syndrome treated with transposition of the left renal vein

　症例は64歳，女性。左側腹部痛と肉眼的血尿を主訴に来院した。DIP（点滴腎盂造影）上，左水腎症を認め，CTではナットクラッカーディスタンスが4mmと短縮していた。左腎動脈造影では，静脈相にて左腎静脈の側副静脈血行路が左尿管を圧排して，水腎症の原因になっていると考えられた。ナットクラッカー現象および側副静脈血行路による左水腎症と診断し，左腎静脈転位手術を施行した。術後経過は良好で，症状は消失し，腎静脈の拡張や水腎症は消失した。

A 64-year-old woman was admitted to our hospital with the complaints of left flank pain and gross hematuria. Cystoscopy revealed bloody urine from the left ureteral orifice. DIP revealed left hydronephrosis and RP revealed kinking of left upper ureter. CT scan demonstrated compression of the left renal vein between the aorta and the superior mesenteric artery. The venous phase of a selective renal angiogram showed dilatation of the mid-renal vein with delayed flow into the inferior vena cava and tortuous dilatated collateral vessels. These images disclosed nutcracker syndrome and left hydronephrosis was caused by compression of these collateral vessels. Since hydronephrosis exists and the symptoms could not be managed conservatively, we carried out the transposition of the left renal vein and successive ligation and transection of collateral vessels. After the surgery, the patient had no further hematuria and left hydronephrosis had disappeared.