Investigating the Abnormal Presentation of Ureteropelvic Junction Obstruction in Adolescence: A Case Report

Ureteropelvic junction obstruction (UPJO) is a common cause of hydronephrosis and is typically diagnosed antenatally. About 70% of these cases will self-resolve; however, symptomatic children may present with abdominal pain (i.e. Dietl crisis), vomiting, rash, or fever.

A 14-year-old male patient presented with cyclical vomiting every two months for the past two years. The patient's mother also described an eight-year history of headaches and intermittent abdominal pain. A renal magnetic resonance urography scan revealed decreased right kidney function and delayed cortex to ureter transit time. A pyeloplasty and stent placement were performed to correct the obstructing vessel.

Clinical guidelines for abdominal pain and cyclical vomiting earlier in the patients' healthcare may have led to an appropriate workup and treatment years before. We recommend physicians consider UPJO as a differential diagnosis in adolescent patients with cyclical vomiting and abdominal pain and consult the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHN) guidelines to better guide the diagnosis.