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Intermittent haematuria and left flank pain

BMJ 2017; 356 doi: (Published 09 February 2017) Cite this as: BMJ 2017;356:i5391

Re: Intermittent haematuria and left flank pain

Would have been very interesting to check on the anatomic status of the left ovary ( imaging) or clinically from a detailed gynaecological history .

For sake of students, it is pertinent to mention that a similar situation in males could additionally present with a left varicocele .
The nut cracker phenomenon is of both anatomic and surgical interest ; very interesting to be able to demonstrate to anatomy students the relative origins of the Coeliac, superior mesenteric and inferior mesenteric arteries from the aorta ; the superior being the only one of the three to have such a steep angular origin from the aorta with a resulting aorto-mesenteric axilla inside which a renal vein or a duodenum could be compressed. That angularity can predispose to the kind of case presented here ( microscopic haematuria) or to varicocele in the male or duodenal obstruction in either sex .

Competing interests: No competing interests

10 February 2017
Basil j Fadipe
Clinical prof surgery/anatomy
Justin fadipe Centre
Mero heights. Commonwealth of Dominica