Kidney Week

Abstract: PUB070

An Uncommon Cause of Left Flank Pain: Pelvic Congestion Syndrome, a Case Report

Session Information

• Publication Only

Category: Bone and Mineral Metabolism

• 502 Bone and Mineral Metabolism: Clinical

Authors

• Demirci, Arif Nihat, Mugla Sitki Kocman Universitesi Tip Fakultesi, Muğla, Turkey

Arif Nihat Demirci, MD

• Sari, Ferda Bacaksizlar, Mugla Sitki Kocman Universitesi Tip Fakultesi, Muğla, Turkey

Ferda Bacaksizlar Sari, MD

• Alp, Alper, Mugla Sitki Kocman Universitesi Tip Fakultesi, Muğla, Turkey

Alper Alp, MD

• Sevkat, Zeynep Rana, Izmir Katip Celebi Universitesi Tip Fakultesi, Izmir, Turkey

Zeynep Rana Sevkat, MD

• Gibyeli Genek, Dilek, Mugla Sitki Kocman Universitesi Tip Fakultesi, Muğla, Turkey

Dilek Gibyeli Genek, MD

• Huddam, Bulent, Mugla Sitki Kocman Universitesi Tip Fakultesi, Muğla, Turkey

Bulent Huddam, MD

Introduction

Flank pain is a symptom characterized by pain located below the ribs and above the iliac crest. It is commonly associated with renal pathologies such as kidney stones. In less common scenarios, the etiology of flank pain may be traced to pathologies involving the gallbladder, gastrointestinal system, or reproductive organs—among them, Pelvic Congestion Syndrome which is characterized by pelvic pain. It is diagnosed through radiologic imaging, which may show dilated gonadal veins and parauterine vein varices.

Case Description

We present an interesting and rare case of a left flank pain due to Pelvic Congestion Syndrome. A 29-year-old female patient presented with a history of severe flank pain for several years. The patient had numerous hospital visits at both primary and secondary care levels, yet no definitive diagnosis was made. In multiple instances, ultrasound imaging suggested the presence of renal stones. A patient presenting to our nephrology clinic with flank pain exhibited no hematuria or proteinuria, and all renal function tests were within normal limits. Other potential diagnoses were excluded based on laboratory results and there were no acute pathological findings on ultrasonography. Subsequently, we reviewed her contrast-enhanced computer tomography (CT) scan, which revealed venous dilatations in the left parauterine region. After that, angiographic imaging of the left renal vein revealed reflux into the left gonadal vein, indicating left gonadal venous insufficiency. Based on these findings a gonadal vein embolization procedure was performed. After the procedure, her flank pain rapidly disappeared and improvement in her quality of life was achieved.

Discussion

Pelvic Congestion Syndrome is typically characterized by chronic pelvic pain. In this case, we aimed to emphasize the effectiveness of diagnosing Pelvic Congestion Syndrome based solely on flank pain, as well as the successful management using minimally invasive interventions.This case underscores the pivotal role of thorough clinical assessment in the diagnostic process. It illustrates that Pelvic Congestion Syndrome, though often overlooked, can be effectively diagnosed through the systematic application of advanced imaging modalities in patients presenting with chronic flank pain and unremarkable laboratory findings.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025ggj831j6