Pelviureteric Junction Obstruction in Crossed Fused Ectopia Presenting as Peritonitis: Case Report and Review of Literature
Mohit Kumar Joshia, Dhananjay Dobhalb
aAssistant Professor, Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi-110029, India. bSenior Resident, Department of Surgery, Government Doon Medical College, Dehradun, Uttarakhand 248001, India.
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Pelvi-ureteric junction obstruction (PUJO) is commonly seen in infants and children. Rarely it may go undetected and presents in adults with either minimal symptoms or is detected incidentally. We report the case of a previously healthy lady aged 26 years who presented with acute abdomen, respiratory distress and shock mimicking peritonitis. During resuscitation, a bedside percutaneous abdominal drain was placed in view her poor general condition. The patient improved dramatically following drainage of intra-abdominal collection and an emergency abdominal exploration was deferred for further diagnostic evaluation. Imaging findings suggested a massively dilated crossed fused ectopic left kidney with PUJO and drain in renal pelvis. A dismembered pyeloplasty was performed electively and the patient made an uneventful recovery. We present the clinical profile and imaging characteristics of this unknown presentation of PUJO with review of unusual clinical presentation of PUJO in adult patients from published literature. We also emphasize that this presentation of PUJO be entertained when dealing with a patient of acute abdomen and shock.