Objective improvement in renal function post-Dietl's crisis: Documented on renal dynamic scintigraphy

Area of Science:

• Pediatric Urology
• Nephrology
• Surgical Case Reports

Background:

• Dietl's crisis presents as intermittent abdominal pain caused by acute hydronephrosis.
• Pelvi-ureteric junction obstruction (PUJO) is a common cause, often due to aberrant renal vessels.
• High ureter insertion is a less frequent etiology of PUJO.

Purpose of the Study:

• To report a case of Dietl's crisis in a child.
• To investigate the cause of intermittent hydronephrosis and abdominal pain.
• To illustrate the diagnostic and therapeutic approach to PUJO.

Main Methods:

• Case presentation of a 5-year-old boy with intermittent abdominal pain and distension.
• Diagnostic imaging included ultrasonography and renal dynamic scan (RDS) with ethylene dicysteine.
• Surgical exploration was performed to identify and treat the cause of obstruction.

Main Results:

• Initial ultrasonography revealed gross left hydronephrosis.
• Initial RDS showed negligible left kidney function.
• Follow-up RDS demonstrated significant improvement in left kidney function and reduced hydronephrosis after spontaneous diuresis.
• Surgical exploration identified high ureter insertion as the cause of PUJO.

Conclusions:

• High ureter insertion can cause Dietl's crisis and PUJO.
• Dynamic changes in kidney function can occur in PUJO.
• Prompt diagnosis and surgical correction are crucial for managing PUJO and associated symptoms.