Spontaneous resolution of ureteric obstruction in perianeurysmal retroperitoneal fibrosis.

Abstract

Retroperitoneal fibrosis (RPF) was first described by Ormond (1948). In this condition a fibrous plaque is deposited in a characteristic retroperitoneal distribution (Skeel et al, 1975). Leakage, either from an aortic (Friedel et al, 1973) or iliac artery aneurysm (Safran et al, 1975), is amongst the many propounded causes. Another hypothesis is that the fibrosis results from an inflammatory response to advanced atherosclerosis (Parums & Mitchinson, 1981) and that periaortitis might be a more logical common descriptive term, embracing both retroperitoneal fibrosis and inflammatory aneurysm (Dixon et al, 1984). In any event, as a result of fibrosis, unilateral or bilateral ureteric obstruction may occur. Treatment often involves surgical release of the ureter (ureterolysis) (Abercrombie & Hendry, 1971), in conjunction with steroids when appropriate (Abercrombie & Vinnicombe, 1980). Spontaneous resolution of ureteric obstruction due to RPF is uncommon: we report such an event in a patient with an aorto-iliac aneurysm. A 79-year-old man was admitted as an emergency with a sixday history of continuous dull pain in the right iliac fossa with some radiation to the umbilical area. This was associated with mild vomiting but no change in bowel habit. He had a left total hip replacement three years before but no other previous surgery. He suffered from chronic bronchitis but on admission was receiving no medication.