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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
PubMed

Insights

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.

Keywords:
Haematology (drugs and medicines)Paediatric SurgeryPathologyPediatricsUrology

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