Urological Complications of Hirschsprung-Related Crohn's Disease: A Case Report

Hirschsprung disease (HSCR) is a rare congenital intestinal disease characterized by the absence of ganglion cells in the myenteric and submucosal plexuses of the intestine. Individuals with HSCR demonstrate a higher risk for inflammatory bowel disease (IBD), with Chron's disease (CD) commonly observed. Renal and urinary involvement is reported by between 4 and 23% of IBD patients, which manifests as urinary calculi, fistulas, and ureteral obstruction, which causes hydronephrosis. Those conditions can lead to a predisposition to recurrent urinary tract infections (UTIs) and should be suspected in male patients with IBD. A 26-year-old male with a history of HSCR and multiple surgeries presented with recurrent UTIs over 3 months. Upon further evaluation, he was found to have hydronephrosis in both kidneys. An MRI of the abdomen with contrast showed thickening and fibrosis in contact with the posterior wall of the rectum, causing a narrowing of the bilateral ureter. This clinical case has been reported to raise awareness of urological complications in CD patients with a history of HSCR, with recurrent UTIs as the presenting symptom.