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Recurrent pelvi-ureteric junction obstruction due to eosinophilic pelvi-ureteritis
Prashant Kothari1, Enono Yhoshu2, Deepali Saxena3
1Paediatric Surgery, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India.
BMJ Case Reports
|August 5, 2025
Summary
Eosinophilic pelvi-ureteritis, an uncommon cause of urinary obstruction, can recur after initial surgery. Prompt diagnosis and combined medical-surgical treatment are crucial for effective management and preserved kidney function.
Area of Science:
- Pediatric Urology
- Inflammatory Conditions
- Renal Pathology
Background:
- Eosinophilic pelvi-ureteritis is a rare inflammatory condition involving eosinophil infiltration in the urinary tract.
- It can manifest with diverse clinical symptoms, including urinary obstruction and reflux.
- Pelvi-ureteric junction obstruction (PUJO) is a common congenital anomaly, but recurrent obstruction can occur.
Purpose of the Study:
- To report a case of recurrent pelvi-ureteric junction obstruction (PUJO) caused by eosinophilic pelvi-ureteritis in a child.
- To highlight the diagnostic challenges and management strategies for this rare condition.
- To emphasize the importance of a multidisciplinary approach in managing eosinophilic pelvi-ureteritis.
Main Methods:
- Case report of a pediatric patient with initial diagnosis of right-sided pelvi-ureteric junction obstruction (PUJO).
- Surgical intervention included laparoscopic pyeloplasty with a double-J stent, followed by redo-laparoscopic pyeloplasty due to recurrent obstruction.
- Histopathological analysis of intraoperative findings revealed eosinophilic infiltration; peripheral eosinophilia was noted.
- Medical management involved corticosteroids, antihistamines, and antihelminthics.
Main Results:
- The patient presented with abdominal lump and gross hydronephrosis, initially treated for PUJO.
- Recurrent PUJO symptoms appeared post-stent removal, necessitating a second surgery.
- Histopathology confirmed eosinophilic infiltration as the cause of obstruction.
- One-year follow-up showed the patient was asymptomatic with preserved renal function under medical management.
Conclusions:
- Eosinophilic pelvi-ureteritis is a rare but significant cause of recurrent pelvi-ureteric junction obstruction (PUJO) in pediatric patients.
- A combined surgical and medical approach, including corticosteroids, antihistamines, and antihelminthics, is effective for managing this condition.
- Early recognition and appropriate treatment are vital for preventing long-term renal damage.
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