The objective of this article is to present the case of a nulliparous female patient with a history of chronic pelvic pain associated with the nutcracker phenomenon (NCP), which was evaluated in our centre, with diagnosis and treatment using endovascular techniques and postoperative results. The case report of an 18-year-old female patient with a status of severe emotional and social deterioration resulting from four years of crippling pelvic pain along with numerous and unsuccessful surgical and medical support treatments is presented. In a review of the symptoms and complementary studies, the presence of pelvic congestion secondary to a NCP was identified as the origin of its clinic, an unusual pathology in nulliparous patients and with no consensus regarding on its optimal treatment. An embolization of the left gonadal vein (LGV) and left gluteal vein with sandwich technique was performed and the self-expanding vein stent was implanted in the left renal vein (LRV).
The patient recovered satisfactorily with immediate relief of pain.
Pelvic congestion syndrome should be considered in the differential diagnosis of chronic pelvic pain, even in nulliparous women. There are a wide range of treatment possibilities for this syndrome, depending on what causes it, clinical status and the anatomic characteristics of each patient. Although there is no standardized endovascular technique, in this case the embolization of the LGV and the left lower gluteal vein as well as the placement of a stent on the LRV, were proved to be safe and effective, with complete remission of pain. Additional studies would be useful to investigate the best treatment in cases of pelvic congestion and NCP.
Corresponding Author: SÄNGER I.|