Giant hydronephrosis in adults: the great mimic. Early diagnosis with ultrasound

Abstract

SummaryGiant hydronephrosis in adults is uncommon and often misdiagnosed clinically. We present three cases of giant hydronephrosis in adults secondary to ureteric calculous obstruction, two of whom presented with an acute abdomen and one with an indirect inguinal hernia. All patients were diagnosed promptly with ultrasound.

Giant hydronephrosis: still a reality!

“…Most common presentation of GH is abdominal lump followed by less common symptoms like flank pain, hematuria, acute abdominal pain and recurrent urinary tract infections. [9,10] Rare presentations of GH include intestinal obstruction, respiratory distress, hypertension, pedal edema, obstructive jaundice and contralateral ureteropelvic junction obstruction. [11] Majority of patients in our study presented with abdominal distension, flank pain and fever.…”

Giant Hydronephrosis Presenting as an Acute Abdomen

“…In rare cases, patients may present with what appears to be an acute abdomen; this finding has been reported in the context of gross intraperitoneal rupture (4,8).…”

“…The most common and efficient diagnostic modalities are CT and ultrasound, yet the diagnosis also can be made by plain films or urography (4)(5)(6). The radiological criteria for the diagnosis of giant hydronephrosis include a hydronephrotic renal pelvis that meets or crosses the midline, occupies a hemi-abdomen, and extends for a length of five vertebrae or more.…”

“…Nephrectomy is usually the treatment of choice, as in most cases there is irreversible damage to the kidney and collecting system (1)(2)(3)(4)(5). Patients with rupture may require emergent exploratory surgery to exclude other causes as well as to evacuate urine and remove the ruptured collecting system (6).…”

Hydronéphrose géante sur rein ectopique pelvien révélée par un syndrome occlusif: Cas rare.

“…Les autres étiologies sont représentées par les lithiases obstructives, les malformations congénitales, les sténoses urétérales, la fibrose rétro-péritonéale voire le traumatisme [3].…”