Tiếng Việt
From a nonspecific symptom to a rare diagnosis
Seven-year-old N.G. traveled from Lang Son to Hanoi French Hospital (HFH) for evaluation of intermittent episodes of abdominal pain. Because abdominal pain is a nonspecific symptom, it can often be attributed to more common gastrointestinal conditions.
However, following evaluation and ultrasound performed by HFH’s pediatric and radiology teams, the child was found to have dilatation of the right renal pelvis and calyces, as well as the upper segment of the right ureter. The findings suggested a possible obstruction to urine flow, but the underlying cause was not immediately clear.
In response to the abnormal ultrasound findings, HFH’s pediatric team consulted with Dr. Nguyen Thu Huong, Head of the Department of Nephrology and Dialysis at the National Children’s Hospital.
Given the unexplained dilatation of the urinary tract, the medical team needed to assess the extent of hydronephrosis and determine whether the cause was an abnormality of the ureter itself or another related anatomical or vascular abnormality. The child was therefore referred for magnetic resonance imaging (MRI) of the urinary tract to more closely evaluate the anatomy and course of the ureter.
The MRI showed that the upper segment of the right ureter passed behind the inferior vena cava, consistent with a diagnosis of retrocaval ureter (RCU).
Retrocaval ureter is a rare congenital anomaly caused by abnormal development of the venous system. When the ureter passes behind the inferior vena cava, part of the ureter can become compressed, obstructing urine flow and causing dilatation of the urinary tract above the obstruction.
RCU often presents without specific symptoms. Children may experience only intermittent abdominal or flank pain; some cases may also be associated with urinary tract infections or blood in the urine.
According to studies published in 2002 by the Departments of Urology and Radiology at the University of Patras, Greece, approximately 21% of RCU cases are associated with urinary and cardiovascular abnormalities. This highlights the importance of recognizing abnormal findings on ultrasound and following up with appropriate imaging when necessary.
MRI can be particularly valuable in evaluating the anatomy of the urinary system and establishing an accurate diagnosis in rare conditions such as RCU.
Diagnosis confirmed, followed by multidisciplinary surgical consultation and minimally invasive surgery
After the MRI confirmed the diagnosis, N.G.’s case was further discussed with Dr. Nguyen Duy Viet, Deputy Head of the Department of Urology at the National Children’s Hospital.
Based on the child’s anatomy and the degree of urinary tract dilatation, the specialists agreed on a surgical approach to relieve the ureteral obstruction, reposition the ureter, and restore normal urine flow.
According to Dr. Nguyen Duy Viet who performed the minimally invasive procedure, RCU is an extremely rare anomaly in clinical practice. Since 2005, he has encountered only seven cases of RCU. The first case was treated with open surgery, while the following six cases were successfully managed using minimally invasive surgery.
Following surgery, N.G. was alert and afebrile, with a clean and dry surgical site. She was able to eat, drink, and resume normal daily activities. The child remained under follow-up to monitor her recovery and assess the condition of the urinary tract following treatment.
When abdominal pain is more than a gastrointestinal problem
What initially appeared to be a nonspecific symptom led HFH’s pediatric team to identify an abnormal finding on ultrasound, consult with nephrology and urology specialists, and order an MRI to clarify the underlying anatomy. Once the diagnosis was established, the case was further coordinated with surgical specialists to determine the most appropriate treatment.
This case highlights the importance of careful clinical evaluation, appropriate diagnostic imaging, and multidisciplinary consultation in identifying and treating rare conditions in children.
At Hanoi French Hospital, complex cases are managed through a coordinated multidisciplinary approach, from identifying an abnormality and establishing an accurate diagnosis to planning and providing surgical treatment. Alongside clinical expertise, surgical safety is a key priority, supported by highly-trained O.T. teams and infection-control protocols.
To receive medical advice or make an appointment with an HFH specialist, please contact our HOTLINE at 024.35771100, send us a message via the “Hanoi French Hospital” Facebook page, or reach us on WhatsApp at +84 903 497 078.
