Surgical treatment of pelvic varicose veins and aorto-mesenteric compression in a 15-year-old girl

Abstract

Introduction. The pelvic congestion syndrome accounts for up to 4% of all causes of chronic pelvic pain in adolescent girls and infrequently may be associated with the obstruction of venous outflow due to compression of the left renal vein resulting in venous hypertension.Case report. A clinical case of surgical treatment of a 15-year-old female patient with the pelvic congestion syndrome and nutcracker syndrome is described. The diagnosis was confirmed by MRI, phlebography with phlebotonometry of the left renal vein and pelvic ultrasound with Valsalva maneuver performed with an empty bladder. Disease symptoms were manifested by chronic pelvic pain and dysmenorrhea. The authors made a gonadoileal bypass with the formation of an end-to-side anastomosis to achieve the most physiological discharge of blood through the gonadal vein and to exclude the formation of stenosis in the anastomosis.Results. 3 months after the surgical treatment, the created gonadoileal bypass functioned well with 30 cm/s blood flow velocity without signs of stenosis and reflux in the ovarian vein.Conclusion. The end-to-side gonadoileal anastomosis is a reasonable curative option in children with the pelvic congestion syndrome and nutcracker syndrome as it has been demonstrated with satisfactory results of shunt functioning at the early and late postoperative periods and an adequate decrease of renal venous hypertension. A multidisciplinary approach is important in the management of pediatric and adolescent patients with chronic pelvic pain and pelvic congestion syndrome for early detection of pathology and its surgical treatment to exclude progression of the disease in adulthood.