IJCRR - Vol 09 issue 10 current issue , May, 2017
Contralateral Perinephric Urinoma Complicated Retrocaval Ureter Repair: A Surgical Trap of Pyelic Fusion Anomaly
Author: Rabea Ahmed Gadelkareem
Aim: To present a case of pyelic fusion anomaly with orthotopic kidneys which is extremely rare. For maximum and only, it was reported twice in the literature. Its diagnosis may be unpredictable and it may predispose to major surgical complications.
Case Report: An 8-year-old child was diagnosed to have a retrocaval ureter which was repaired through a flank incision. A striking finding of a cut and retracted tubular structure was noted during ureteral dissection. Postoperative contralateral perinephricurinoma developed and drained percutaneously. Then, two surgical explorations were done on the left kidney without detection of a cause for urinary extravasation. The left ureter was atretic during explorations. Kidney autotransplantation and ileal reconstructions seemed difficult solutions and nephrectomy was the final step.
Discussion: Pyelic fusion anomaly was reported, mainly, in association to renal fusion anomalies like horseshoe and crossed ectopic kidneys. However, it is the first time to report a case of retrocaval ureter in association to pyelic fusion and normally-located and positioned kidneys. Contralateral urinoma after repair of a retrocaval ureter was a striking complication referred to an underlying crossing left-to-right anomalous pathway. This case represented a surgical trap, because it is an extremely rare and unpredictable association of renal anomalies.
Conclusion: Pyelic fusion with orthotopic well-positioned kidneys is an extremely rare renal anomaly. Its association to retrocaval ureter makes it extremely unpredictable, especially, when it is undiagnosed preoperatively.
Keywords: Pyelic fusion, Retrocaval ureter, Surgical trap, Urinoma
Rabea Ahmed Gadelkareem. Contralateral Perinephric Urinoma Complicated Retrocaval Ureter Repair: A Surgical Trap of Pyelic Fusion Anomaly International Journal of Current Research and Review. Vol 09 issue 10 current issue , May, 32-34
1. Ram, A.D., Thomas, R.E., Malone, P. A new operative technique for a rare case of pyelic fusion. J Pediatr Urol, 2011 Oct. 7(5): p. 574-5.
2. Yesilli, C., Erdem, O., Akduman, B., et al., Horseshoe kidney with pyelic fusion and crossed single ureter. J Urol, 2003 Jul. 170(1): p. 175-6.
3. Aragona, F., Serretta, V., Fiorentini, L.,et al., Combined renal and pyelic fusion with crossed ectopia of single ureter. Urology, 1986 Oct. 28(4): p. 339-41.
4. Brueziere, J., Fretin, J. A new case of pyelic fusion. Eur Urol, 1980 6(4): p. 249-50.
5. Enganti, B., Chitekela, N., Nallabothula, A. K., et al., Renal pyelic fusion with crossed solitary ureter: case report and review of literature. Int J Urol, 2013 Oct. 20(10): p. 1043-5.
6. Bhat, S., Paul, F., Doddamani, S.C. Renal pyelic fusion anomaly. Indian J Urol, 2015 Apr-Jun. 31(2): p. 148-9.
7. Cybulka, B., Podgorny, M., Rapela, J., Wach, A. Surgical trap of a routine procedure. scrotal hernia with concomitant sliding of the urinary bladder: Case report. Pol Przegl Chir, 2015 Nov. 87(11): p. 587-91.
8. Hassan, R., Aziz, A.A., Mohamed, S.K. Retrocaval ureter: the importance of intravenous urography. Malays J Med Sci, 2011 Oct-Dec. 18(4): p. 84-7.
9. McInerney, D., Jones, A., Roylance, J. Urinoma. Clin Radiol, 1977 May. 28(3): p. 345-51.