Left ureteral appendiceal interposition: Exercise caution and do not be mislead by postoperative radiological obstruction

Postoperative imaging after appendiceal ureteral interposition may be difficult to interpret, misguiding the urologist towards intervention. We present a case in which radiological obstruction was not endorsed by a 99TcDTPA nephrogram, with favorable outcome after conservative treatment.

Authorship

Aderivaldo Cabral Dias FilhoCorrespondence address: Aderivaldo Cabral Dias Filho, MD, Unidade de Urologia Hospital de Base do Distrito Federal SHS Quadra 101 Área Especial s/n, 8° andar, Asa Sul Brasília, Distrito Federal, 70335-900, Brasil. Telephone: + 55 61 3315-1479 E-mail: urohbdf@gmail.com

Unidade de Urologia, Hospital de Base do Distrito Federal, Brasília, DF, BrasilHospital de Base do Distrito FederalBrasilBrasília, DF, BrasilUnidade de Urologia, Hospital de Base do Distrito Federal, Brasília, DF, Brasil

Carlos Alberto Toledo Martinez

Maria Bianca Côrte

Unidade de Proctologia, Hospital de Base do Distrito Federal, Brasília, DF, BrasilHospital de Base do Distrito FederalBrasilBrasília, DF, BrasilUnidade de Proctologia, Hospital de Base do Distrito Federal, Brasília, DF, Brasil

Marcus Vinicius Osorio Maroccolo

Correspondence address: Aderivaldo Cabral Dias Filho, MD, Unidade de Urologia Hospital de Base do Distrito Federal SHS Quadra 101 Área Especial s/n, 8° andar, Asa Sul Brasília, Distrito Federal, 70335-900, Brasil. Telephone: + 55 61 3315-1479 E-mail: urohbdf@gmail.com

CONFLICT OF INTEREST

None declared.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (3)

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Figure 1
Upper Left: Intraoperative photograph showing proximal (black arrow) and distal ureteroappendiceal anastomoses (blue arrow). The mesoappendix can be seen on the medial aspect of the appendix; Right: Intravenous pyelogram 29 days after removal of the double-J stent showed left pyeloureterectasis and obstruction at the proximal ureteroappendiceal anastomosis (black arrow). Lower left: 99TcDTPA nephrogram displayed pyeloureteroectasis but adequate drainage of the left renal unit.

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Figure 2
Curved multiplanar 3-dimensional reconstruction images of the right (left image) and left (right image) urinary tracts at the excretory phase two years after the operation: On the right, one observes the sites of the proximal anastomosis (yellow arrowhead), where the dilated, thin-walled left ureter joins the thick-walled appendix. The red arrowhead points to the distal appendicoureteral anastomosis. The green lines (3-dimensional Bézier paths) threads along both urinary tracts, from upper posterior calices to ureterovesical junctions. RK, right kidney; LK, left kidney

Thumbnail

Figure 3
Coronal view of computed tomography at the nephrographic phase two years after the operation. One observes mild to moderate left pyeloectasis and good cortical contrast uptake.

Figure 1 Upper Left: Intraoperative photograph showing proximal (black arrow) and distal ureteroappendiceal anastomoses (blue arrow). The mesoappendix can be seen on the medial aspect of the appendix; Right: Intravenous pyelogram 29 days after removal of the double-J stent showed left pyeloureterectasis and obstruction at the proximal ureteroappendiceal anastomosis (black arrow). Lower left: 99TcDTPA nephrogram displayed pyeloureteroectasis but adequate drainage of the left renal unit.

Figure 2 Curved multiplanar 3-dimensional reconstruction images of the right (left image) and left (right image) urinary tracts at the excretory phase two years after the operation: On the right, one observes the sites of the proximal anastomosis (yellow arrowhead), where the dilated, thin-walled left ureter joins the thick-walled appendix. The red arrowhead points to the distal appendicoureteral anastomosis. The green lines (3-dimensional Bézier paths) threads along both urinary tracts, from upper posterior calices to ureterovesical junctions. RK, right kidney; LK, left kidney

Figure 3 Coronal view of computed tomography at the nephrographic phase two years after the operation. One observes mild to moderate left pyeloectasis and good cortical contrast uptake.

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Left ureteral appendiceal interposition: Exercise caution and do not be mislead by postoperative radiological obstruction

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[1] Correspondence address: Aderivaldo Cabral Dias Filho, MD, Unidade de Urologia Hospital de Base do Distrito Federal SHS Quadra 101 Área Especial s/n, 8° andar, Asa Sul Brasília, Distrito Federal, 70335-900, Brasil. Telephone: + 55 61 3315-1479 E-mail: urohbdf@gmail.com