दुर्भाग्य से, यह वेबसाइट हिंदी में नहीं बल्कि जर्मन या अंग्रेजी में उपलब्ध है

Severe right-sided abdominal pain radiating down into the right leg due to a combination of three different compressions of the inferior vena cava: The jellyfish effect, compression by the right renal artery and lordotic

compression in midabdomen

A 33-year-old female patient suffered daily from severe right-sided upper abdominal pain (9/10 for 3 hours per day), which radiated towards the right groin (7/10 for 1 hour per day) and the right leg (7/10 for 2 hours per day). The symptoms started one year ago, after the birth of a healthy daughter. The patient had difficulty eating and had to restrict her food intake to frequent small meals, avoiding meat as it was less well tolerated than fluid or soft food. She was constantly nauseous and had lost 10 kg in body weight.

Sonography revealed multiple compressions of the inferior vena cava and subsequent acceleration of blood flow, indicating an increase in pressure, which caused the above-described pain. The sonographic examination revealed that her inability to eat a sufficient amount of food to maintain her weight was due to a spatial conflict between the bowel and the vena cava.

The exaggerated lumbar lordosis, combined with a flat thorax, significantly reduced the space in the abdominal cavity, particularly in front of the spine. The minimum distance between the spine and the abdominal wall was only 12 mm.

This creates a permanent conflict between the filled bowel and the vena cava. The small bowel requires approximately 20 mm, while the large bowel requires 30–40 mm due to filling with food as soon as peristaltic waves arrive.

Sonography could demonstrate this conflict precisely, not only in the mid-abdominal region, where the lordotic curvature compressed the small bowel, but also in the upper abdomen, where, despite the reclining upper lumbar spine, the available space for the stomach, the right liver lobe, the right renal artery, the transverse colon, and the vena cava was only 4 cm. This resulted in the vena cava being compressed almost constantly by the right renal artery and to a lesser extent by the transverse colon.

The following video clearly demonstrates these findings. Within the video, due to a slip of the tongue, ‘adenomyoma’ was said instead of ‘adenomyosis’.

This case report is typical of patients presenting with pain in the right upper quadrant.