Idiopathic retroperitoneal fibrosis. A sometime surgical problem.

The study was undertaken to focus attention on idiopathic retroperitoneal fibrosis, which may confront any surgeon operating in the abdomen or retroperitoneal area. Eleven patients, six men and five women varying in age from 35 to 76 years, were treated from 1969 to 1983. Two patients gave a history of methysergide and one gave a history of ergotamine ingestion. Two patients had associated aortic aneurysms and two had renal artery stenosis. Symptoms were related to entrapment of retroperitoneal structures, primarily the ureter, vena cava, gonadal veins, the aorta and its branches. Abdominal and costovertebral angle pain, testicular pain and swelling, and renovascular hypertension were the most common symptoms. The most common differential diagnostic problem was retroperitoneal tumor. Intravenous or retrograde pyelography were suggestive of the diagnosis in five patients, ultrasonography in two, and computerized axial tomography in another. Treatment consisted of ureterolysis and intraperitoneal transplantation or omental wrapping of the ureter in five, nephrostomy in two, renal-iliac arterial bypass graft in two, and renal autotransplantation in one. One patient was treated conservatively. Good results were achieved in eight, fair results in two, and one patient died postoperatively. Idiopathic retroperitoneal fibrosis should be kept in mind diagnostically in patients with unexplained abdominal pain and/or retroperitoneal lesions, and the surgeon prepared to employ appropriate operative measures for relief when it is encountered.