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Case Reports
. 2023 Oct:111:108899.
doi: 10.1016/j.ijscr.2023.108899. Epub 2023 Oct 3.

Retrocaval ureter in a child presenting at a regional referral hospital in South-Western Uganda: A case report

Oscar Atwine  1 , Denis Mucunguzi  2 , Johnson Ebine  2 , Racheal Ainomugisha  3 , Joshua Muhumuza  4 , Marvin Mutakooha Mwesigwa  2
Affiliations
Case Reports

Retrocaval ureter in a child presenting at a regional referral hospital in South-Western Uganda: A case report

Oscar Atwine et al. Int J Surg Case Rep. 2023 Oct.

Abstract

Introduction and importance: Retrocaval ureter is a rare developmental abnormality of the inferior vane cava. Commonly presents in the 3rd and 4th decades of life hence a rare presentation in the pediatric population. This condition presents a surgical challenge both in terms of diagnosis and management due to costly investigations and few urology specialists in resource limited settings. We present a case of retrocaval ureter surgically managed in a resource limited setting with excellent outcome.

Case presentation: A 13-year-old female presented with 3 months history of progressive right sided abdominal pain and history of treatment for recurrent lower urinary tract infections. Intravenous pyelogram showed a ureter with a fish hook shape. At laparotomy, the ureter was identified, divided, relocated and ureteroureterostomy done anterior to the inferior vena cava. The patient recovered with no complications.

Discussion and conclusion: To the best of our knowledge, this is the first reported case of retrocaval ureter in a child surgically managed in Africa. It's a congenital anomaly of the inferior vena cava not ureter hence a misnomer. Amidst of being in a less resourced setting, an intravenous pyelogram may be all that is required to make a diagnosis.

Keywords: Case report; Inferior vane cava abnormality; Pediatric; Resource limited setting; Retrocaval ureter.

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Conflict of interest statement

Conflict of interest statement None.

Figures

Fig. 1
Fig. 1
Intravenous pyelogram taken after 5 h showing fish hook sign (Black arrow) indicating ureteric obstruction due to retrocaval ureter.
Fig. 2
Fig. 2
Dilated proximal ureter before curving behind the inferior vena cava.
Fig. 3
Fig. 3
Retrocaval ureter passing behind the inferior vena cava with the distal ureter collapsed whereas the proximal ureter is dilated and forms a shape of a hook.
Fig. 4
Fig. 4
Intra-operative ureteroureterostomy after resection of the obstructed part of the ureter, the dilated proximal segment is anastomosed to the spatulated collapsed distal segment of the ureter.
See this image and copyright information in PMC

References

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