Department of Urology, Muhimbili National Hospital, Dar es Salaam, Tanzania.
Department of Surgery, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
J Med Case Rep. 2024 Nov 28;18(1):573. doi: 10.1186/s13256-024-04942-0.
The retrocaval ureter is a rare congenital anomaly resulting from abnormal development of the inferior vena cava. The obstruction is usually at the retrocaval segment of the ureter, as it lies between the inferior vena cava and the body of the third lumbar vertebra. Computed tomography intravenous urography is the gold standard for investigating this condition and can reveal ipsilateral hydronephrosis and the fishhook sign or sickle sign of the proximal ureter, depending on the type of retrocaval ureter.
We present the case of a 30-year-old African female who presented with intermittent dull right flank pain for 3 years. Computed tomography intravenous urography revealed isolated moderate right hydronephrosis with a fishhook sign in the proximal ureter. Surgical correction was performed, and the patient was followed for 6 months with improved renal function.
Surgery remains the sole definitive management of the retrocaval ureter for symptomatic patients and those with worsening hydronephrosis or differential renal function.
胡桃夹综合征(retrocaval ureter)是一种罕见的先天性异常,由下腔静脉异常发育引起。梗阻通常发生在输尿管的逆行段,因为它位于下腔静脉和第三腰椎体之间。静脉尿路造影计算机断层扫描(computed tomography intravenous urography)是研究该病的金标准,可根据胡桃夹综合征的类型显示同侧肾积水和输尿管近端的鱼钩征或镰刀征。
我们报告了一例 30 岁的非洲女性患者,她间歇性出现右腰部钝痛 3 年。静脉尿路造影计算机断层扫描显示孤立性中度右肾积水,输尿管近端呈鱼钩征。进行了手术矫正,患者随访 6 个月,肾功能得到改善。
对于有症状的患者以及肾积水或肾功能差异恶化的患者,手术仍然是治疗胡桃夹综合征的唯一确定性方法。