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IMAGES IN PRACTICE |
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| Year : 2017 | Volume
: 22
| Issue : 3 | Page : 189-190 |
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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 |
Correspondence Address:
Ravi Prakash Kanojia
Department of Pediatric Surgery, APC, PGIMER, Chandigarh - 160 012
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0971-9261.207633
 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).[1] 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).[2] 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.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | 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.  |
| 2. | 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]
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