Giant hydronephrosis due to neglected congenital pelvi-ureteric junction obstruction: a case report and literature review.

INTRODUCTION: Giant hydronephrosis is defined as having 1.5 L or 1.6% of body weight of fluid in the renal pelvis. In the exception of a few, the preponderance of giant hydronephrosis is attributable to congenital anomalies, mostly pelvi-ureteric junction obstruction (PUJO). However, giant hydronephrosis could also be attributed to ureteric calculi, ureteral tumors or trauma. We report the case of a giant hydronephrosis in a 14-year-old African female, with a review of the etiology and peculiarities of management in an African context.

CASE PRESENTATION: A 14-year-old female presented with a year's history of a left flank swelling with progressive distension, pain and heaviness of the abdomen. The patient denied any history of early morning facial puffiness, pedal oedema, nausea, vomiting, constipation, fever, chills or hematuria. Physical examination was significant for a young female whose general condition was stable. The abdomen was distended, extending from the left flank to the right lumbar and iliac fossa regions. An abdominopelvic CT scan showed a huge left-sided intra-abdominal cystic lesion with pelvicalyceal dilatation, severe cortical thinning and features suggesting a chronic left PUJO and minimally dilated right renal pelvis. A left simple nephrectomy was performed. Findings were a grossly dilated left renal pelvis, cortical thinning, and 10.4 L of urine.

CONCLUSION: Giant hydronephrosis is mostly a consequence of neglected congenital renal anomalies in Africa. Nephrectomies may be considered in selected advanced cases. The nephrectomized patient must avoid unprescribed medications, including herbal concoctions as excretion is now dependent on a solitary kidney.