diet for nutcracker syndrome

Nutcracker phenomenon and nutcracker syndrome. Superior Mesenteric Artery Syndrome Combined with Renal Nutcracker Syndrome in a Young Male: A Case Report. Yes, the truth is that the brain is a chemical factory. As a library, NLM provides access to scientific literature. If this imbalance is not corrected, the brain goes into a permanent and severe state of depression, which then affects your mood and makes it difficult to achieve an even diet in the future. WebSuperior mesenteric artery syndrome (Wilkies syndrome) is a rare cause of intestinal obstruction caused by a congenital or acquired reduction of the aorto-mesenteric angle leading to duodenal compression. The ultrasound examination found an aortomesenteric angle of 18 and compression of the left renal vein and left varicocele. We can help her.. WebGetting enough vitamins and calcium in the diet, or as extra supplements; Nutritional counseling; Exposure to infections, parasites, or toxins a unilaterally enlarged tonsil; and if the child is ill-appearing, a retropharyngeal abscess, epiglottitis, or Lemierre syndrome should be suspected. Co-occurring superior mesenteric artery syndrome and nutcracker syndrome requiring Roux-en-Y duodenojejunostomy and left renal vein transposition: a case report and review of the literature. In our opinion, based on this experience, in patients with weight loss and post-prandial pain, diagnostic investigations should also be extended to the study of the aorto-mesenteric angle to confirm or exclude any vascular compression. a diet that can improve the quality of life of people with Nutcracker syndrome, recommended and to avoid food He proposed an embolization, a procedure that involves placing coils in ovarian veins to prevent blood from pooling. I knew how crazy I looked, but I couldnt handle another negative test.. I want to eat the nutcracker. Nutcracker or jackhammer esophagus targets the smooth muscles that usually move food seamlessly from your throat down to your stomach. Newer, 3-D high-resolution manometry tracings instead reveal a strong, repetitive pattern of contractions that look the pounding of a jackhammer all the way down the esophagus in some patients, says Dr. Gabbard. A "beak sign" can often be seen in CT scans due to the LRV compression. WebTreatment Among the options for helping people with nutcracker esophagus are: Anti-reflux therapy. Nutcracker syndrome can be hard for doctors to diagnose, but once its diagnosed, the outlook is often good. (2017). I started to really wonder if I was what everyone else thought I was: a hypochondriac, an awful person who doesnt play with her kids.. Renal autotransplantation: transfer of a kidney from its original location into the body to another location to prevent venous compression. Vasc Med. Some had been reliant on narcotics. POEM. In many cases in children, nutcracker syndrome with mild symptoms will resolve itself within two years. Blood samples can be used to check blood cell counts and kidney function. (C) Color Doppler scans, performed in supine decubitus position, in the pampiniform plexus, demonstrate regression of the left varicocele (maximum vein diameter <1.9 mm). Diagnosis of nutcracker syndrome is challenging due to the absence of definite and uniform criteria [ 5 ]. Last medically reviewed on August 8, 2018. Left renal vein transposition for nutcracker syndrome. The doctor was curt. When medications and peppermint oil dont help, the next step isbotulinum toxin injections. the contents by NLM or the National Institutes of Health. (2016). [6]In all cases for open procedures, data is limited for long term follow-up. Prevention of Nutcracker Syndrome is not always possible, but maintaining a healthy weight and avoiding activities that put pressure on the abdomen may help reduce the risk of compression. 1Although not life-threatening, nutcracker syndrome can limit patient quality of life due to severity of symptoms. First, your doctor will perform a physical exam. After six years she finally had an answer and it wasnt that she was crazy. If you have overactive bladder, it may, Overactive bladder (OAB) symptoms can increase your risk for anxiety and depression. If you told me I needed to cut my pinkie off right now and I would be pain free I would do it! she remembers telling him. Med Int (Lond). Policy. It is a diet that is low in carbohydrates, high in protein and fat, and uses the right Published by Elsevier Inc. on behalf of University of Washington. In our case, the ultrasound finding of an aorto-mesenteric angle reduction (<22) and an aorto-mesenteric distance reduction (<8 mm), associated with flow congestion in the left renal vein with consequent left varicocele, allowed the diagnosis of nutcracker syndrome, while stenosis of third distal duodenal revealed by CT examination allowed diagnosis of Wilkies syndrome. Save my name, email, and website in this browser for the next time I comment. [5] Patients may also have orthostatic proteinuria, or the presence of protein in their urine depending on how they sit or stand. CONCLUSIONS Superior mesenteric artery syndrome is to be suspected in patients with abdominal pain following weight loss. Pelvic congestion can indicate the presence of nutcracker syndrome, which occurs when the left renal vein that carries blood purified by the left kidney becomes compressed, obstructing blood flow. Botox. Since Ive been on a diet for such a long time, Ive found that many of the Free Metrics We avoid using tertiary references. Her internist ordered a urinalysis that detected blood in her urine. Some people are born with certain blood vessel variations that can lead to symptoms of nutcracker syndrome. Also known as the nutcracker syndrome. Our investigation revealed superior mesenteric artery syndrome as well as a compressed left renal vein. HHS Vulnerability Disclosure, Help Learn preventive steps you can. By continuing you agree to the use of cookies. Wheat and other grains including gluten (oats, barley and rye) are problems for Nutcracker phenomenon and nutcracker syndrome. Write for us Carb Diet, Recipes, Desserts, Salads, Appetizers. Heres what causes it and how its treated. Cleveland Clinic 1995-2023. When this happens, the food gets stuck in the esophagus. Oh MJ. If youre eating a lot of sugar and fat then you are in this condition that is caused by an imbalance of how your brain works at a cellular level. Medications that may help treat nutcracker esophagus include: calcium channel blockers proton pump inhibitors nitrates, such as sublingual nitroglycerin This rare vascular disorder can cause pain and other symptoms but can be difficult to diagnose. What Is Nutcracker Syndrome? In nutcracker syndrome, your left renal vein gets compressed by two nearby arteries in your abdomen. Computed tomography angiography showing the compression of the duodenum (Du) between the superior mesenteric artery (SMA) and the aorta. It is a condition where the brain cells are unable to properly process these simple sugars and fats. These are called the renal veins. [11], Nutcracker syndrome is diagnosed through imaging such as doppler ultrasound (DUS), computed tomography (CT), magnetic resonance imaging (MRI), and venography. Next, your doctor may recommend a Doppler ultrasound of your kidney area to see if you have abnormal blood flow through your veins and arteries. -, Raman SP, Neyman EG, Horton KM, et al. In the past four years, Redfield said, the Wisconsin team has evaluated about 200 patients and performed autotransplants on about 80. NCS is divided based on how the LRV travels, with anterior NCS being entrapment by the SMA and AA and posterior NCS being compression by the AA and spinal column. Am J Case Rep. 2020 Apr 22;21:e922715. After transplant her pain disappeared, along with her need for opioids, Redfield said. So does esophageal spasm. Ultrasonography is the first-line exam for the diagnosis of nut-cracker syndrome; it allows clinicians, with high sensitivity, to measure the angle and aorto-mesenteric distance and to assess the congestion of the left renal vein and the presence of the left varicocele. Next, theyll take a medical history and ask about your symptoms to help them narrow down a possible diagnosis. The doctor then ordered a CT scan of her abdomen and pelvis. Anomalies of the inferior vena cava and renal veins and implications for renal surgery. These two modalities can be used to confirm other evidence for NCS such as back-up of blood flow into the ovarian veins. Here, we report the case of a patient with a rare combination of these 2 syndromes and with unusual clinical manifestation of post-prandial pain. Her seven-hour surgery performed by Redfield was followed by six days in the hospital and 11 days in a nearby residence for transplant patients. Yes, no spicy stuff. And her supportive husband was opposed, worried that she was rushing into surgery based on unsubstantiated information on Facebook. Clipboard, Search History, and several other advanced features are temporarily unavailable. Bland scheduled the procedure, then canceled it fearing it might prove ineffective. ScienceDirect is a registered trademark of Elsevier B.V. ScienceDirect is a registered trademark of Elsevier B.V. A man with the rare simultaneous combination of three abdominal vascular compression syndromes: median arcuate ligament syndrome, superior mesenteric artery syndrome, and nutcracker syndrome, https://doi.org/10.1016/j.radcr.2021.02.065. But he cautioned that the procedure might worsen her nutcracker symptoms. Computed tomography angiography showing the compression of the duodenum (Du) between the superior, Computed tomography angiography showing the left renal vein (LRV) compression between the superior, Sagittal computed tomography angiography showing, Sagittal computed tomography angiography showing the acute takeoff of the superior mesenteric artery, MeSH But it's so unhelpful when I'm already getting sick and nauseous form pain! The scan of the left renal vein, performed at the renal hilum, showed a diameter of about 11 mm (Figure 1B) and a maximum speed of about 12.1 cm/s (Figure 1C). Clinical Procedure: Endovascular stent grafting, Specialty: Gastroenterology and Hepatology Radiology. In addition to conservative measures, more invasive therapies include endovascular stenting,[5] renal vein re-implantation,[14] and gonadal vein embolization. A nutcracker. 2017 Nov 25;70(5):253-260. doi: 10.4166/kjg.2017.70.5.253. Patient with both Wilkie syndrome and nutcracker syndrome. Nutcracker syndrome is an eating disorder. Among them was a teenager who was receiving a continuous Dilaudid drip. If you have chest pain, its imperative to rule out a cardiac cause, Dr. Gabbard stresses. Bland also fervently hoped testing would reveal an underactive thyroid, which can cause lethargy; both parents and her sister had been treated for thyroid disorders. Bland was initially undeterred. Symptomatic patients may undergo imaging tests to diagnose nutcracker syndrome. Ultrasound scans performed in the pampiniform plexus showed the presence of left varicocele (Figure 1D). The preferred treatment when symptoms are mild consists of a high-calorie diet to induce the restoration of normal layer of peri-vascular adipose tissue and normal angulation of the aorto-mesenteric angle [6]. Apostu RC, Chira L, Colcear D, Lebovici A, Nagy G, Scurtu RR, Drasovean R. World J Clin Cases. (C) This scan shows the compression of the left renal vein (white arrow). This article was published more than2 years ago. Are any of them serious? eCollection 2021 Oct. See this image and copyright information in PMC. About half of those who cant tolerate blood pressure medicine respond to peppermint oil, he says. Superior mesenteric artery syndrome accompanying with nutcracker syndrome: A case report. Unauthorized use of these marks is strictly prohibited. The legs of this nutcracker, with some imagination, could represent the two arteries, squeezing whatever is stuck between them. [12] Following catheterization, venography is done to visualize the vasculature and can provide confirmatory diagnosis of NCS prior to stenting. Its about being a little nutcracker, but not a complete nutcracker. The patient underwent ultrasound examination with B-mode, color, power, and duplex Doppler of the abdomen. During open enrollment a few months later, Blands husband switched their insurance to a plan that covered treatment out of state. After reading an explicit warning on the website of a support group for nutcracker patients, she canceled the procedure. Inal M, Unal Daphan B, Karadeniz Bilgili MY. Overview. In those with nutcracker syndrome due to certain medical conditions or tumors, correcting the blood flow problem requires correcting or treating the underlying cause. The ultrasound scans showed a reduction of the aorto-mesenteric angle (18), measured at the origin, and aorto-mesenteric distance (7 mm) measured at 2 cm from the origin; a compression of left renal vein in the tract of passage between the superior mesenteric artery and aorta (diameter <3 mm) (Figure 1A). Before 2008 Aug;13(3):247-50. doi: 10.1177/1358863X08092272. Taking a calcium channel blocker before eating helps about 75% of patients with swallowing, says Dr. Gabbard. Its not uncommon for patients to have a significant psychological impact because of what has gone on, he said. In the following days, he had a gradual regression of post-prandial pain. PMID: 28356209. In 2018, a new and supportive internist sent her for a colonoscopy and ordered tests for celiac disease, a common autoimmune disorder caused by eating gluten, and H pylori, the bacteria that causes ulcers. 2. She took her husband, Jeff, to the appointment to attest to her fatigue. The specific causes of nutcracker syndrome can vary. Although less invasive, risks involved include incorrect placement of the stent as well as stent dislodging and migration to the right atrium. Spontaneous rupture of the ovarian vein in association with nutcracker syndrome: a case report. This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (, Mesenteric Artery, Superior; Renal Nutcracker Syndrome; Superior Mesenteric Artery Syndrome; Ultrasonography, Doppler, Color. I have celiac disease and I am on a completely gluten free diet. Why the condition, also called jackhammer esophagus, is missed. Theres a lot of research that shows that when a persons diet is unhealthy, their brain chemistry changes. Once jackhammer esophagus or esophageal spasm are diagnosed, treatment involves relaxing the esophagus muscles using: 1. 2013 Mar;26(1):35-42. doi: 10.1053/j.semvascsurg.2013.04.006. 4. Loin pain hematuria syndrome, Sollinger said in an email, is believed to originate in the ureter where repeated spasms cause pain he likened to continually passing a kidney stone.. Many different medical conditions can cause swelling in your legs, which can create the urge to pee. The test involves the injection of a local anesthetic into the ureter. These spasms can prevent food from reaching the stomach. Wilkie's syndrome as a cause of anxiety-depressive disorder: A case report and review of literature. [6], Laparoscopic procedures involve laparoscopic spleno-renal venous bypass and laparoscopic LRV-IVC transposition. Pregnant women may be advised to avoid lying on their backs for extended periods of time. (2009). Tell your doctor whats going on. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); No Carb Dietis a ProfessionalBlogPlatform. One study found that it helped esophageal spasm, so it should also help jackhammer esophagus.. [12] Although robotic surgery is possible, data on robotic procedures is limited concerning outcomes and cost-effectiveness. Apparently I have superior mesenteric artery syndrome. Ahmad KS, Alenazi NA, Essa MS, et al. achalasia, and nutcracker esophagus. Patient, of normal weight with a body mass index of 20, had reported rapid weight loss following a low calorie diet with loss of 14 kg in past 4 months. [10], In normal anatomy, the LRV travels between the SMA and the AA. Kurklinsky AK, et al. Nutcracker syndrome (NCS) is a rare condition characterized by a group of clinical manifestations, like hematuria and pain, and is most commonly due to compression of a left renal vein (LRV) between the superior mesenteric artery and the aorta. DOI: Gulleroglu K, et al. official website and that any information you provide is encrypted (2014). Funding: This study was not supported by any funding. (A) The aorto-mesenteric angle (short arrow) and the aorto-mesenteric distance (long arrow) appears reduced, at 18 and 7 mm, respectively. Auto transplant surgery February 2019. Pelvic congestion syndrome often occurs during or after pregnancy, when varicose veins develop around the ovaries. The symptomatology is non-specific and is common to many other abdominal pathologies; the most frequent signs they are belching, abdominal fullness and post-prandial pain, biliary re-flux, and biliary vomiting and nausea. Read previous mysteries at wapo.st/medicalmysteries. Kawanishi K, Shojima K, Nishimoto M, et al. 2010 Jun;85(6):552-9. doi: 10.4065/mcp.2009.0586. Please enable it to take advantage of the complete set of features! A case report]. Ask for manometry.. The CT confirmed compression of the duodenum (Figure 2A, 2B) and compression of the left renal vein (Figure 2C). A CT study was performed to exclude oncological diseases and/or other pathologies responsible for the pain and weight loss, which confirmed the ultrasound findings and showed compression of the third part of the duodenum. Nausea and vomiting can result due to compression of the splanchnic veins. The ultrasound scan promptly highlighted the reduction of the aorto-mesenteric angle and the signs of venous congestion of the left renal vein. In nutcracker syndrome, symptoms are most often caused when the left renal vein coming from the left kidney becomes compressed and blood cant flow normally through it. Abdominal aorta (short arrow). Farina R, Foti PV, Cocuzza G, et al. Nutcracker syndrome can be classified as either anterior or posterior. Federal government websites often end in .gov or .mil. Superior mesenteric artery syndrome: A radiographic review. That was a big game changer, she said. PMID: 20511485; PMCID: PMC2878259. [8] Patients with NCS have a tendency to have a tall and lean stature, as this can lead to a narrower gap between the SMA and the AA for the LRV. Left renal vein entrapment syndrome, or nutcracker syndrome (NCS), is characterized by extrinsic compression of the left renal vein (LRV), most commonly between the aorta (Ao) and superior mesenteric artery (SMA),[1] however anatomic variations might exist, and it might be underdiagnosed and undertreated. Her internist referred her to a gynecologist who didnt know how to treat her. Nutcracker syndrome in pregnancy: a worrying presentation of a benign condition. 2014 Nov 6;3(4):277-81. doi: 10.5527/wjn.v3.i4.277. But she faced an even bigger obstacle: Her insurance did not cover out-of-state treatment. On clinical examination abdomen was tense and painful and pain increased after compression. Correcting the condition depends upon the cause. Your doctor can insert it by cutting a small slit in your leg and using a catheter to move the stent into the proper position inside your vein. (B) The reconstruction according to a sagittal plane show the characteristic vascular pattern of Wilkies syndrome with aorta and superior mesenteric artery taking on the beak-like appearance (black arrow). Orthostatic proteinuria has also been reported. CT scan of the abdomen. WebFollow a heart-healthy diet thats low in cholesterol, fat and salt. A 69-year-old man came to our attention for rapid weight loss, postprandial epigastric pain and recurrent vomiting for at least 6 months. There are several different procedures available to manage NCS include: LRV transposition is the most common procedure done followed by renal autotransplantation and LRV bypass. They might also recommend a kidney biopsy to help rule out other conditions that can cause similar symptoms. Advertising on our site helps support our mission. (2011). Normally she didnt pay a lot of attention to pain: She had a high threshold and had twice given birth without painkillers. The .gov means its official. Diagnosis and surgical management. Copyright 2023 Elsevier B.V. or its licensors or contributors. However, there can be variations. Cicero G, DAngelo T, Bottari A, et al. Recovery from surgery depends on the type of surgery and your overall health. Heres How To Find Relief for Your Acid Reflux, Chest Pain in Young Athletes: When You Should Be Concerned. He looked at me and said, You realize you are crying because your bloodwork is normal? she recalled. But manometry is the only way to diagnose these muscle disorders, Dr. Gabbard notes. Median arcuate ligament syndrome and superior mesenteric artery syndrome are well-known abdominal compression syndromes, the coexistence of which is rarely described in literature. Then a scan provided a life-changing clue. Bowel & Digestive Health 2012;37(6):107988. It can also lead to re-routing of venous blood flow through collateral veins and backflow of venous blood into other organs resulting in symptoms such pelvic pain, dysmenorrhea in women and testicular pain in men. There is a wide spectrum of clinical presentations and diagnostic criteria are not well defined, which frequently results in delayed or incorrect diagnosis. Both entities, although well described in the literature, are individually rare, and even though they might share a common etiology, their co-existence has been reported in only a few case reports. And it often goes undiagnosed. I was hospitalized Hi! Ultrasound does not allow a complete diagnostic assessment since the study of duodenal compression diagnostic integration with other methods such as RM-enterography [14], fluoroscopy [15], and endoscopy [16] is necessary. After a volley of wrong guesses, the 7-year-old excitedly blurted out, You, Mom! Bland remembers fighting back tears. Nutcracker syndrome can have a variety of clinical presentations with no uniform diagnostic criteria. Children may be given time to grow and weight gain can help others. 2022 Mar 17;2(2):10. doi: 10.3892/mi.2022.35. Ultrasound in diagnosis of superior mesenteric artery syndrome. Successful nutritional therapy for superior mesenteric artery syndrome. Your doctor might recommend a variety of surgical procedures to relieve pressure on the vein. Pulgarin Ricardo LG, et al. What each clinical anatomist has to know about left renal vein entrapment syndrome (nutcracker syndrome): A review of the most important findings. Superior mesenteric artery syndrome: Spectrum of CT findings with multiplanar reconstructions and 3-D imaging. Epub 2017 Mar 27. Stomach pain was ruining her life. The diet for nutcracker syndrome is one that focuses on eating mostly nutrient-dense foods in small amounts that are easily digested and metabolized. Side Stitch: What It Is and How To Get Rid of the Pain, Have Heartburn? She was admitted to the Emergency Department The most common clinical manifestations of nutcracker syndrome are left flank pain, pelvic pain, haematuria and gonadal varices. Eur J Vasc Endovasc Surg. Color Doppler scans of the left renal vein and pampiniform plexus after the positioning of the endovascular stent. [6], Since the left gonadal vein drains via the left renal vein, it can also result in left testicular pain[7] in men or left lower quadrant pain in women, especially during intercourse and during menstruation. Mental healthcare helps treat these conditions and may address, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Extravascular stent management for migration of left renal vein endovascular stent in nutcracker syndrome. J Pers Med. Farina R, Foti PV, Coronella M, Pennisi I, Libra F, Di Mari A, Gozzo C, Vasile T, Lamirata E, Veroux M, Basile G, Basile A. Radiol Case Rep. 2021 Aug 6;16(10):2998-3002. doi: 10.1016/j.radcr.2021.07.004. But in other cases it can lead to a poorly understood disorder first described more than 50 years ago called loin pain hematuria syndrome, which can result in blood in the urine and severe abdominal pain. DOI: Tian L, et al. -, Yakan S, Calskan C, Kaplan H, et al. It was the best birthday present I ever had, she recalled. 1. government site. Were dedicated to providing you the best ofBlog, with a focus on dependability andCarb Diet. She said she was unable to function 80 percent of the time and worried that Dr. The "usual course" of renal nutcracker syndrome (NCS) is not clear and it remains under-diagnosed because symptoms vary from person to person. In some cases, more commonly in children, it can resolve spontaneously. However, without treatment, it can predispose a person to left renal vein thrombosis (a blood clot in the vein) and kidney damage. There are two main types of nutcracker syndrome: anterior and posterior. Nutcracker syndrome isnt inherited. I've done some research on the Internet, and it says people get the nutcracker syndrome because of untreated celiac disease. Accessibility HHS Vulnerability Disclosure, Help The elective surgical treatment consists of resection of the first duodenal loop and retro-vascular duodenum and in the packaging of the anastomosis between the duodenum and the second duodenal loop, which are carried anteriorly. DeSantis critical of China, hazy on Ukraine as he charts foreign policy path. However, like any procedure, there are risks. Who will protect women from the courts and legislatures? The problem is that as people gain weight in a healthy way they tend to get less happy. Left inferior vena cava with nutcracker syndrome: A case report. Attili A, Ang D. Medial rotation of the duodenum with duodenal duodenostomy: A novel surgical approach for the management of superior mesenteric artery syndrome. Im not a nutcracker. Its often misdiagnosed as a heart attack or acid reflux.. Superior mesenteric artery syndrome following esophageal cancer surgery: A report of two cases and a literature review. [12] They are uncommon in comparison to open procedures, but the outcomes of such procedures are similar to those of open procedures. The preferred treatment when symptoms are mild consists of a high-calorie diet to induce the restoration of normal layer of peri-vascular adipose tissue and normal angulation of the aorto-mesenteric angle [6]. Epub 2022 Oct 27. A major operation, autotransplant involves removing the affected kidney and ureter, the tube that carries urine from the kidney to the bladder, and relocating it to the other side. But some cant tolerate the blood pressure medicine.. The most frequent is the form, in which the reduction of the aorto-mesenteric angle is due to a reduction of the fat surrounding the abdominal aorta and superior mesenteric artery, mainly caused by rapid weight loss, which is very common in anorexic patients [4]. Symptoms are more common in females in their 20s and 30s, but it can affect anyone of any age. 2022 Feb 16;10(5):1654-1666. doi: 10.12998/wjcc.v10.i5.1654. No unsolved cases, please. WebRenal nutcracker syndrome (NCS) is a condition that occurs when the left renal vein (the vein that carries blood purified by the left kidney) becomes compressed. [6], CT and MRI can be used afterward to confirm compression by the AA and SMA with comprehensive measurements of the abdominal vasculature. Redfield said he often speaks with the spouses of potential transplant patients whose marriages and other relationships are strained. The other 2 therapeutic approaches are surgical treatment [7] and endovascular stenting [8]. We describe the case of a young male patient with rapid weight loss, coupled with post-prandial abdominal pain, with sub-acute onset, not associated with other symptoms. His ankle hurt first. In anterior nutcracker syndrome, the left renal vein is compressed between the aorta and another abdominal artery. Learn about nephroptosis, including causes, symptoms, and treatment options. 4. DOI: Nickavar A. [8] Occasionally, the LRV travels behind the AA and in front of the spinal column. B-mode Ultrasound: longitudinal sub-xyphoid scan of the abdominal aorta performed in supine decubitus position and scans of the left kidney in right lateral decubitus performed before treatment. A rare cause of recurrent abdominal pain; the coexistence of Wilkie's syndrome and nutcracker syndrome. Medication. And it often goes undiagnosed. Redfield would call me and tell me he didnt think I was a candidate after all. After spending six years battling worsening pain, Olivia I.