Ramírez GS, Gutiérrez SJ, Núñez RNR, Maldonado VÁJ, Hernández RS, Carranza CH, García OL

Language: Spanish
References: 19
Page: 105-108
PDF size: 253.47 Kb.

ABSTRACT

May-Thurner syndrome is a clinical condition that results from narrowing of the left common iliac vein lumen due to pressure from the right common iliac artery as it crosses anterior to it. We describe an atypical case of May-Thurner syndrome in a 23-year-old woman that presented only continuous pain in pudendal zone without vascular symptoms. The Doppler ultrasound, nuclear magnetic resonance and others complementary analyses show the presence of a pelvic venous congestion syndrome and we hypothesized that this condition produced a neuropathic compression of the pudendal nerve in Alcock’s canal. Patient was treated with the technique of pudendal nerve blockade by trans-gluteal via. An important reduction in pain of pudendal zone was showed.

REFERENCES

1. May R, Thurner J. The cause of predominately sinistral occurrence of trombosis of the pelvic veins. Angiology 1957;8:419-417.

2. Moudgill N, Hager E, Gonsalves C, Larson R, et al. May-Thurner syndrome: Case report and review of the literature involving modern endovascular therapy. Vascular 2009;17:330-335.

3. Suwanabol PA, Tefera G, Schwarze ML. Syndromes associated with the deep veins: Phlegmasia cerulea dolens, May- Thurner syndrome, and nutcracker syndrome. Perspect Vasc Surg Endovasc Ther 2010;22:223-230.

4. Ferris EJ, Lim WN, Smith PL, Casali R. May-Thurner syndrome. Radiology 1983;147:29-31.

5. Sathler CCM, Lins BMV, Rivas YJA. Tratamiento endovascular del síndrome de May-Thurner: Informe de caso y revisión de la literatura. Rev Bras Ecocardiog Imagem Cardiovasc 2012;25:122-125.

6. Leal MJ. Indicaciones y tratamiento del síndrome de congestión pélvica. Flebología y linfología: Lecturas vasculares 2010;5:841-847.

7. Leal MJ, Zubicoa ES, Chocrón EA, Sánchez AG, Galano RU. Síndrome congestivo pélvico: revisión. En: Vaquero C, Ros E, editores. Procedimientos terapéuticos oclusivos endovasculares. Valladolid: Gráficas Andrés Martín, 2010;197-205.

8. Yamamoto N, Koyano K. Neurovascular compression of the common peronela nerve by varicose veins. Eur J Vasc Endovasc Surg 2004;28:335-338.

9. Bendszus M, Rieckmann P, Perez J, Koltzenburg M, et al. Painful vascular compression syndrome of the sciatic nerve caused by gluteal varicosities. Neurology 2003;61:985-987.

10. Moser T, Scheiber-Nogueira MC, Nogueira TS, Doll A, et al. Pudendal nerve compression by pelvic varices: successful treatment with transcatheter ovarian vein embolisation. J Neurol Neurosurg Psychiatry 2006;77:1 88.

11. Ramsden CE, McDaniel MC, Harmon RL, Renney KM, Faure A. Pudendal nerve entrapment as source of intractable perineal pain. Am J Phys Med Rehabil 2003;82:479-484.

12. Beco J, Climov D, Bex M. Pudendal nerve decompression in perineology: a case series. BMC Surg 2004;4:15.

13. Cil EB, Akpinar E, Carcaaltincaba M, Akinci D. Case 76: May- Thurner syndrome. Radiology 2004;233:361-365.

14. Labat JJ, Riant T, Amarenco G, Lefaucheur JP, Rigaud J. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes Criteria). Neurourol Urodyn 2007;27:306-310.

15. Itza FS, Salinas J, Zarza D, Gómez FS, Allona AA. Update in pudendal nerve entrapment syndrome: an approach anatomic-surgial, diagnostic and therapeutic. Actas Urol Esp 2010;34:500-509.

16. Shafik A, Doss SH. Pudendal canal: surgical anatomy and clinical implications. Am Surg 1999;65:176-180.

17. Ribeiro JCJ, Queiroz DN, Azambuja FF, Petorossi GS, et al. Endovascular treatment of iliac vein compression syndrome (May-Thurner). A case report. J Vasc Bras 2011;10:72-76.

18. Hough DM, Wittenberg KH, Pawlina W, Maus TP, et al. Chronic perineal pain caused by pudendal nerve entrapment: Anatomy and CT-guide perineural injection technique. Am J Roentgenol 2003;181:561-567.

19. McDonald JS, Spigos DG. Computed tomography-guide pudendal block for treatment of pelvic pain due to pudendal neuropathy. Obstet Gynecol 2000;95:306-309.