Co-existing pelvi-ureteric junction obstruction and retrocaval ureter in a 7-year-old Nigerian girl: a case report

Pelvi-ureteric junction obstruction is a common cause of upper urinary tract obstruction in children and most often due to congenital anomaly of pelvi-ureteric junction. It is the most common cause of significant hydronephrosis in children. It is associated with many congenital urologic anomalies. Retrocaval ureter is a congenital anomaly of the ureter resulting in varying degree of proximal ureteral obstruction. Though retrocaval ureter is associated with many congenital anomalies, it is infrequently reported in association with pelvi-ureteric junction obstruction. There is no data report of co-existing pelvi-ureteric junction obstruction and retrograde ureter to the best of our knowledge. Clinical presentation of pelvi-ureteric junction obstruction occurs commonly as flank pain in older children and adults.

We present our experience in the diagnosis and management of a 7-year-old Nigerian girl with co-existing right pelvi-ureteric junction obstruction and retrocaval ureter in a Nigerian tertiary hospital. A 7-year-old girl who presented with 2-year history of colicky right flank pain. She had been to several hospitals with no definitive diagnosis or effective treatment. Computerized Tomography Urogram (CTU) showed right moderate hydronephrosis with non-visualization of right ureter which precluded preoperative diagnosis of retrocaval ureter. At surgery through an open flank extraperitoneal approach, a right hydronephrosis, stenotic right pelvi-ureteric junction and normal right retrocaval ureter were found. Excision of stenotic segment, retrieval of retrocaval ureter and Anderson-Hynes pyeloplasty was done over 3Fr DJ stent. Postoperative period was not adversely eventful.

Pelvi-ureteric junction obstruction can co-exist with retrocaval ureter. If both are responsible for ureteral obstruction, it may pose challenges to reconstruction. It is therefore important for urologists to be aware of possible associations and treatment challenges that may result.