IMAGES IN PRACTICE
|Year : 2017 | Volume
| Issue : 3 | Page : 189-190
Retrocaval ureter: Clinical images
Pradeep Agrawal1, Ravi Prakash Kanojia1, Akshay Saxena2
1 Department of Pediatric Surgery, PGIMER, Chandigarh, India
2 Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India
|Date of Web Publication||8-Jun-2017|
Ravi Prakash Kanojia
Department of Pediatric Surgery, APC, PGIMER, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Retrocaval ureter (RCU) is a rare congenital anomaly with the ureter looping around inferior vena cava (IVC). We present the case of 10-year-old boy. Diagnosis was confirmed with ultrasound and CT. He underwent retroperitoneoscopic uretero-ureterostomy.
Keywords: Hydronephrosis, pediatric, retrocaval ureter, retroperitoneoscopy
|How to cite this article:|
Agrawal P, Kanojia RP, Saxena A. Retrocaval ureter: Clinical images. J Indian Assoc Pediatr Surg 2017;22:189-90
| Introduction|| |
Retrocaval ureter (RCU) is a rare congenital anomaly with the ureter looping around inferior vena cava (IVC). Although it is a congenital anomaly, the patient presents later in life, from a resulting hydronephrosis. The hydronephrosis is due to kinking of the ureter. We present a 10-year-old boy with right flank pain and associated right hydronephrosis. The diagnosis was confirmed with ultrasound and computed tomography (CT). He underwent retroperitoneoscopic ureteroureterostomy.
| Case Report|| |
A 10-year-old child presented with a 2 years history of right flank pain, intermittent colicky, or dull aching in nature. The child was not hypertensive. Physical examination was unremarkable. Abdominal ultrasonography revealed a right hydronephrosis with prominent right upper ureter. CT urography was done as a part of academic interest showed right hydronephrosis and moderate dilatation of right upper ureter up to 4.5 cm. The ureter seen looping behind IVC with a normal course in distal part [Figure 1]. The images showed classical fish hook appearance for RCU.
|Figure 1: Computed tomography urography showing the looping right ureter with a fish hook appearance. The proximal ureter is dilated|
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The patient underwent retroperitoneoscopic surgery. The intraoperative findings confirmed the diagnosis of right RCU it was seen looping around the IVC [Figure 2]. The procedure carried out involved mobilization and dividing the ureter at the medial borders of the IVC. An uretero-ureteric anastomosis using vicryl 5-0 suture was carried out after untangling it with IVC without tension with the placement of a double-J ureteric stent.
|Figure 2: Retroperitoneoscopic view of the right ureter seen looping around inferior vena cava|
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RCU is a rare anomaly. Diagnosis can be made with the help of ultrasound and urography (intravenous, CT or by magnetic resonance imaging). The treatment is as it was done in this case. The images provided give a clear understanding of the anomaly for a surgeon to understand and identify. The prognosis is excellent if treated adequately.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Kenawi MM, Williams DI. Circumcaval ureter: A report of four cases in children with a review of the literature and a new classification. Br J Urol 1976;48:183-92.
Bass FE, Redwine MD, Kramer LA, Huynh PT, Harris JH Jr. Spectrum of congenital anomalies of the inferior vena cava: Cross-sectional imaging findings. Radiographics 2000;20:639-52.
[Figure 1], [Figure 2]