nut-cracker case
July 14, 2020

Thanks to dr.Amira Baredhwan for her amazing presentation 


15 years old female patient, medically free, presented with chronic recurrent history of abdominal pain , that is variable in severity , requiring sometimes hospital admission , she underwent both upper and lower scope with no definite diagnosis, what would be your approach ? DDx ? and how would you manage ?


you will approach the patient based on patient stability, looking for red flags, and ruling out serious causes ,then looking for ddx of abdominal pain


this patient was admitted under gastro team , CT abdomen was done and showed that she has no evidence of demoniacal pain , however found to have anterior nut-cracker syndrome


key points:

  • anterior nutcracker phenomena = findings without symptoms , while anterior nutcracker syndrome = findings with symptoms
  • nutcracker syndrome can be congenital or acquired especially post spinal surgeries, significant weight loss.
  • medical treatment including encouraging weight gain