An unusual cause of unilateral urinary tract obstruction

Abstract

A 69-YEAR-OLD WOMAN was admitted to the emergency department of our hospital with a 6-h history of intermittent abdominal pain that had developed suddenly. She had no history of abdominal surgery, but she suffered from cholecystolithiasis for about 2 years, and there had been 2 similar episodes in the past year. Physical examination revealed tenderness of the right upper and middle abdomen. Laboratory tests, including blood and urine analysis, were within normal limits, except that blood neutrophil counts increased to 8.73 3 10/L. A computed tomography (CT) scan demonstrated that the gallbladder was filled with stones and lying anterior to the ureteropelvic junction, with the right renal pelvis and ureter dilated (Fig 1). An upright abdominal x-ray showed that the gallbladder descended into the pelvis, lying beside the vertebral column, where the right ureter enters the pelvis (Fig 2, arrow). Because both CT scans and an abdominal x-ray did not show the presence of urinary stone or tumor, the unilateral dilation of right renal pelvis and ureter was supposed to be caused by the compression of a gallbladder stone. At that time, cholecystectomy