Chronic, nonspecific, postinfectious, retroperitoneal fibrosis and ureteral obstruction

Two cases of severe ureteral obstruction following nonspecific, postinfectious, chronic retroperitoneal fibrosis are described, which both originated by a primitive intestinal pathology.

This complication was observed in two women: first, 65 years old, submitted for ulcerative colitis to a total proctocolectomy, with ileo-pouch-anal anastomosis, complicated by an anastomotic fistula; and second, 66 years old, operated with an extended left hemicolectomy, for an adenocarcinoma of the recto-sigmoid colon complicated with a vaginal fistula. In these cases, computerized tomography demonstrated a unilateral hydronephrosis, secondary to a complete obstruction of the ureter; a subsequent nephro-ureterectomy became necessary. Histology demonstrated nonspecific inflammatory lesions.

Postinfectious, chronic inflammation of the retroperitoneum acts on the ureteral and peri-ureteral tissues, inducing an inflammatory and then a fibrotic process.

We underline the opportunity of a precocious and radical treatment of every retroperitoneal infection.