Abstract
A 42-year-male presented with history of acute pain in the left lumbar area of 4 hours duration. There was no fever, pyuria or bacteruria on presentation, nor any history sug-gestive of urinary tract infection or stone disease in the past. However he had taken various over-the-counter analgesics in the past 10 years to relieve similar pain episodes.Physical examination was unremarkable. Hematological and biochemical parameters were within normal limits and urine culture was sterile. X-ray of the kidney-ureter-bladder (KUB) area revealed a 14 × 10 cm radio-opacity in the left lumbar area, overlapping the left sacro-iliac joint. Intravenous pyelogram (IVP) showed good excretion on both sides with gross hydroureteronephrosis (HDUN) on the left side due to a strange radiodense shadow in the left hemipelvis (Fig. 1). Contrast enhanced CT (CeCT) was done to ascertain the diagnosis – was it a foreign body; or DFDOFL?HGJURZWK RUDFDOFXOXVZLWKLQDGLYHUWLFXOXPRUdue to some ureterocoele. But the radiological dilemma persisted.Preoperative cystourethroscopy showed normal bladder PXFRVDDQGXUHWHULFRUL?FH+RZHYHUWKHLQWUDPXUDOSDUWRIWKHOHIWXUHWHUVHHPHG?OOHGXSIURPZLWKLQ>@$iFPUDGLRGHQVHRSDFLW\ZDVFRQ?UPHGXSRQAXRURVFRS\8QVXUHDERXWWKH?QDOSUHRSHUDWLYHGLDJQRVLVthe abdomen was opened with a midline vertical incision.The left ureter was found to be grossly dilated to the extent of 9 cm with a stony hard content within (Fig. 2). The
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