Fig 2 - available via license: CC BY-NC-ND
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Intraoperative picture showing dilated upper ureter (UU) with narrowed lower ureter (LU) caused due to compression by crossing vessels (CV). The Crossing vessels lie in close proximity to Cord structures (CS) and the Vas deferens (V).
Context in source publication
Context 1
... He wanted only definitive surgical man- agement. Patient underwent retrograde pyelography which revealed significant lower ureteric obstruction. Subsequently, he underwent Laparotomy by extra-peritoneal approach. An anoma- lous vessel, probably an aberrant gonadal vein was compressing the lower ureter causing narrowing with upstream dilatation (Fig. 2). A single large vessel was observed coursing along with the cord structures and then taking an angulated turn to compress the lower ureter at the pelvic brim, consistent with the site of obstruction on the IVP. Hence, we presumed it to be an aberrant Gonadal vein due to its proximity to cord structures. The strictured ureteric segment ...
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Citations
... Raghavendran et al. resected the stenotic ureteric segment and performed ureterocystoneostomy. No clinical symptoms were reported in the one-year follow-up [10]. ...
Introduction and importance
There is sparse literature about lower ureteric obstruction due to aberrant blood vessels. We report a case of a patient who was referred to our hospital due to left sided flank pain caused by external compression of the distal ureter.
Case presentation
A 47-year-old male patient presented with left sided flank pain. A computed tomography scan revealed external compression of the lower ureter. Hypertrophy of the psoas muscle due to extensive cycling for 20 years lead to concomitant kinking and elongation of the iliacal vessels which caused the distal ureteric obstruction. Robotic-assisted laparoscopic ureterocystoneostomy with psoas hitch technique was performed.
Clinical discussion
Lower ureteric obstruction, mostly seen in children, is mostly caused by vascular anomalies such as a persistent umbilical artery. After literature review, we presume it to be the first reported case of distal ureteric obstruction caused by external vascular elongation.
Conclusion
The external elongation of pelvic vessels due to excessive cycling and the concomitant extrinsic compression of the distal ureter should be considered as rare but possible cause of lower uretic obstructions.
Presented here is the case of a 21-year-old man, with a family history of unilateral renal agenesis, who presented with obstruction of his solitary functioning right kidney. Initially thought to be secondary to an obturator fossa hernia on endoscopic and retrograde pyelography assessment, diagnosis of obstruction secondary to an aberrant middle rectal artery was determined at laparotomy and division of this vessel relieved the patient’s obstruction without any short-term or long-term complications. To the best of the authors’ knowledge, this is the first reported case in the literature of hydroureteronephrosis secondary to an aberrant middle rectal artery.
