Pelviureteric Junction Obstruction in Right Ectopic Pelvic Kidney and Left Blind Ureter: A Rare Case Report

Abstract

One in seven neonates on antenatal scan detected hydronephrosis has Pelviureteric Junction Obstruction (PUJO), making PUJO one of the most common cause of congenital urinary tract obstruction, with an incidence of one in 1000 to one in 2000 live births. Hereby, the authors present a case report of 19-year-old female who presented with pain in abdomen since, two weeks. There was no history of dysuria, haematuria. No history of lower urinary tract symptoms. No history of fever. There was no history of co-morbidity. No similar episodes of pain in past. All blood investigations were within normal limits with serum creatinine of 0.78 mg/dL. Computed Tomography (CT) Intravenous Urography (IVU) showed right ectopic kidney with Pelviureteric junction obstruction with left small atrophic kidney. Diethylenetriaminepentaacetic Acid (DTPA) reported crossed fused kidneys. Two investigations gave two different diagnoses. It made diagnosis and treatment challenging. Cystoscopy showed two ureteric orifices are normal position. Retrograde pyelogram showed left blind ureter. Right pelvic kidney was seen. Delayed drainage of contrast made diagnosis of pelvi ureteric junction obstruction. So it ruled out diagnosis of crossed fused kidneys with help of cystoscopy and retrograde pyelogram. Such anomalous kidneys are rare to find in day to day life. As anomalous kidneys usually have abnormal blood supply it makes surgery challenging. Abnormal position of kidney, malrotation makes surgery difficult. So decision was made to do open surgery for present patient. Open pyeloplasty was performed for right pelvi ureteric obstruction. Also, DTPA interpretation as anatomical investigation should be used with pinch of salt.

Keywords

• congenital kidney disease
• pyeloplasty
• retrograde pyelography
• solitary functioning kidney