Dietl Syndrome Misattributed to Gastrointestinal Disease in a Child: A Pediatric Diagnostic Pitfall

Dietl syndrome is a rare manifestation of intermittent ureteropelvic junction (UPJ) obstruction characterized by episodic abdominal pain, nausea, and vomiting. In pediatric patients, symptoms are frequently misattributed to gastrointestinal or functional disorders, resulting in delayed diagnosis and potential irreversible renal injury. Diagnostic challenges can result in advanced disease before the underlying obstruction is recognized. Although gastrointestinal etiologies, such as constipation and functional abdominal pain, are common and reasonable initial considerations in pediatric patients, persistent or recurrent symptoms should prompt reconsideration of the differential diagnosis. We present a case of a nine-year-old boy with recurrent abdominal pain initially attributed to gastrointestinal causes who was ultimately found to have severe UPJ obstruction with markedly impaired renal function requiring nephrectomy. This case highlights the importance of thoughtful evaluation and early imaging in children with unexplained recurrent and episodic abdominal pain.