An anomalous development of infra-renal inferior vena cava leads to circumcaval ureter or preureteral vena cava, a rare congenital anomaly with an autopsy incidence of 0.9 per 1000. We present a case of circumcaval ureter and review the literature with a special emphasis on the paradigm shift seen during the last decade, in diagnostic and management strategies.
A 24-year old male, came to the Urology department, Lifeline hospital, with history of discharge from the umbilicus. On examination, it was detected as infected remant of urachus. Routine investigations were done. USG reported as ill defined hypoechoic tender tubular lesion underneath parietal wall in the midline infraumbilical region, suggestive of urachal sinus. MRI reported as findings of Urachal sinus extending for a distance of approximately 2.5 cm. A hypotense tract with narrow fluid filled lumen was extending from the umbilicus inferiorly for 2.5 cm approximately in length, beneath the anterior abdominal wall [Table/ Fig-1]. No evidence of collection beneath the umbilicus. Urinary bladder had normal thickness. The patient was treated with antibiotics, and surgical excision [Table/ Fig-2] of the urachus was done, and during the surgery, cystoscopy was also done. The physician examined for malignancy and found none. Histopathological report indicates chronic inflammatory disease. He was discharged with medications and was advised to do follow up. The patient had come for follow up after 2 weeks, then 4 weeks and then after 3 months and 6 months. He was examined and found no recurrence of the condition.
A JJ stent is inserted antegradely after percutaneous renal procedures like percutaneous nephrolithotomy (PCNL) for renal calculus disease, and for endopyelotomy for pelvi-ureteric junction obstruction. We describe a technique for antegrade stent insertion after PCNL.
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