PUJ obstruction with crossing renal vessels - a case report of failed laparoscopic vascular hitch

Abstract

Purpose Dismembered pyeloplasty has been the traditional technique in the management of pelviureteric junction obstruction (PUJO) secondary to crossing renal vessels in children. Laparoscopic transposition of lower pole vessels for PUJO has been described in children as well as adults. Material and Methods We report a child with PUJO secondary to lower pole renal vessels who underwent laparoscopic transposition of vessels. The child had persistent PUJO, which was later treated with laparoscopic dismembered pyeloplasty. Results After transposition of the lower polar vessel, the patient had persistent PUJO. Conclusions Laparoscopic transposition of renal vessels is a simple technique, and requires less operating time. It involves no anastomosis or insertion of temporary DJ stent. However as of now there are no imaging techniques or Intraoperative procedures to confirm that the crossing renal vessels are the sole etiology for PUJO. Till such time one should use this option carefully.