案例報告: 間質性膀胱炎女性合併骨盆腔靜脈鬱血與胡桃鉗症候群

蘇奕瑋、黃建榮、薛又仁、賴昱維、蕭毅君、李淑文、陳修聖、邱文祥

台北市立聯合醫院仁愛院區外科部泌尿科

A case report: Pelvic congestion syndrome with nutcracker syndrome in a female with interstitial cystitis   

Yi-Wei Su, Andy C. Huang, Thomas Y. Hsueh, Yu-Wei Lai, Yi-Chun Hsiao, Shu-Wen Li, Shiou-Sheng Chen, Allen W. Chiu

Division of Urology, Department of Surgery, Taipei City Hospital Renai branch

Introduction:

Interstitial cystitis (IC) is a chronic and debilitating condition characterized by pelvic pain, urinary urgency, and frequency. Some IC patients may also have accompanying conditions such as endometriosis, chronic pelvic pain syndrome, and pelvic congestion syndrome, which can further exacerbate their pelvic pain. In this case presentation, we discuss the case of a 56-year-old woman with IC who also had pelvic congestion syndrome and nutcracker syndrome.

Case presentation: 

A 56-year-old woman with a medical history of major depressive disorder presented at our Genitourinary (GU) outpatient department with complaints of lower abdominal and pelvic pain. She had been experiencing urinary frequency and urgency for several years. Initial urine analysis was within normal limits. To confirm the diagnosis of IC, she was admitted for hydrodilation with cystoscopy, which revealed the presence of Hunner lesions, confirming the diagnosis of IC.

Subsequent abdominal CT scans revealed prominent bilateral ovarian veins, indicative of pelvic congestion syndrome, and identified the nutcracker phenomenon in the left renal artery. She experienced partial improvement after hydrodilation and was discharged smoothly. Further hyaluronic acid treatment for IC was being administered through the National Health Insurance (NHI) of Taiwan, and she was referred to the cardiovascular surgery department for the treatment of her vascular disease.

Conclusion:

        Interstitial cystitis is a complex disease that can often be complicated by co-occurring conditions, leading to exacerbated pelvic pain and significantly affecting the patient's quality of life. A comprehensive assessment of patients with IC, including a thorough medical history, physical examination, and appropriate laboratory and imaging studies, is essential for an accurate diagnosis and treatment planning. It is crucial to simultaneously address the multiple causes of pelvic pain in such cases. Effective management and close follow-up of patients with these co-occurring conditions are of paramount importance to improve their overall well-being and symptom control.