Expect the unexpected

Abstract

To describe our experience with a series of 3 children with the most common congenital uropathy, pelviureteric junction obstruction (PUJO), presenting with uncommon or life-threatening complications from the PUJO itself, or complications of pyeloplasty surgery. The first case (5 year old) presented obtunded with malignant hypertension and PRES (posterior reversible encephalopathy syndrome). She was found to have a severe PUJO with a ruptured renal calyx and large compressive sub capsular urinoma. This Page-kidney type phenomenon was driving the severe hypertension. She was managed with a drain for the sub-capsular urinoma, medical hypertension control and emergency retrograde JJ stent insertion across the PUJO. The second case (infant) presented in acute renal failure and was found to have bilateral PUJO on imaging. She underwent emergency retrograde JJ stenting of the more severely hydronephrotic kidney. The third case (infant) presented with recurrent PUJO and underwent Redo Pyeloplasty. Post-operatively, the distal end of the JJ stent was coiled in the lower ureter, causing a complete obstruction at the VUJ, with perinephric leak from the pyeloplasty wound. The lower end of the stent was negotiated into the bladder with the help of a ureteroscope and without disturbing the pelvic end of the JJ stent. Case1-Recovered well, hypertension resolved and pyeloplasty done electively. Case2-Renal parameters normalised after JJ stent placement, followed by elective pyeloplasty. Case 3-Perinephric leak settled, JJ stent removed after 8 weeks. PUJO, a common uropathy, can be associated with uncommon and severe complications: requiring awareness, prompt diagnosis and astute timely management to tide over the threatening scenarios.