Journal of Indian Association of Pediatric Surgeons
Journal of Indian Association of Pediatric Surgeons
                                                   Official journal of the Indian Association of Pediatric Surgeons                           
Year : 2017  |  Volume : 22  |  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

Correspondence Address:
Ravi Prakash Kanojia
Department of Pediatric Surgery, APC, PGIMER, Chandigarh - 160 012


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.

How to cite this article:
Agrawal P, Kanojia RP, Saxena A. Retrocaval ureter: Clinical images.J Indian Assoc Pediatr Surg 2017;22:189-190

How to cite this URL:
Agrawal P, Kanojia RP, Saxena A. Retrocaval ureter: Clinical images. J Indian Assoc Pediatr Surg [serial online] 2017 [cited 2023 Feb 2 ];22:189-190
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Full Text


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}

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}

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.

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Conflicts of interest

There are no conflicts of interest.


1Kenawi 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.
2Bass 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.