Pediatric nutcracker syndrome (PNS) represents a rare disease in childhood and presents with symptoms such as flank pain and intermittent hematuria when the left renal vein is compressed between the abdominal aorta and the superior mesenteric artery. Management ranges from conservative treatment with mild symptoms to invasive approaches like open surgery or endovascular interventions.

Given the cosmetic drawbacks of open surgery and the risk of stent migration in pediatric cases, we review treatment options and outcomes for PNS. We also present a 13-year-old patient treated with robot-assisted laparoscopic transposition of the left renal vein with three-dimensional image reconstruction a novel technology, highlighting its cosmetic advantages.

In this case report, we present a 13-year-old female patient with a chief complaint of intermittent flank pain for six years, which worsened, accompanied by hematuria in the past month due to a common cold. Ultrasound, computed tomography and three-dimensional image reconstruction of the urinary system revealed compression of the left renal vein, with an inner diameter of 1.2 mm and a distal lumen diameter of 9.1 mm. The angle between the abdominal aorta and the superior mesenteric artery was 18°. The patient was diagnosed with PNS. After undergoing robot-assisted laparoscopic transposition of the left renal vein, the patient experienced complete resolution of abdominal pain symptoms.

We reported a case of pediatric nutcracker syndrome, aiming to discuss the surgical options and novel technology for its treatment in the PNS population and to review the literature on its management and prognosis.