Ureter an innocent bystander in unusual vascular compression syndromes: Presentation and management

Abstract :

Objective: Abdominopelvic vascular compression syndromes occur when the vascular structures either cause compression or are compressed by the surrounding hollow viscera. Apart from retrocaval ureter and UPJO, ureteric compression by other vascular structures is rare. We present five rare cases of ureter compression caused by inferior mesenteric vein, testicular vein, ovarian vein, common iliac arteries and an unnamed tributary of inferior vena cava respectively.Methods: Retrospective data of all cases of hydroureteronephrosis between January 2019 and March 2020 was studied. Out of the 659 cases identified, search was narrowed to keywords like vascular compression ,ureteric compression and crossing vessels. 11 cases were identified. Excluding 6 cases of UPJO, we were left with five cases of extrinsic ureteric compression caused by other vascular structures.Results:Case 1 was a 26 year old man with ureteric compression by inferior mesenteric vein. Case 2 was a 27 year old man with incidental intraoperative finding of left testicular vein compressing the upper ureter. Case 3 was a 38 year old female with dilated upper ureter due to compression by right ovarian vein. Case 4 was a 19 year old female with compression of bilateral mid-ureters by common iliac arteries. Case 5 was a 26 year old man with upper ureteric stricture due to a crossing tributary of IVC. Conclusion:Extrinsic compression of the ureter is an important cause of proximal hydronephrosis and hydroureter. This series highlights albeit rare but clinically significant causes of vascular compression on the ureter. Sequelae of such syndromes include silent hydronephrosis, urolithiasis and pyelonephritis. Treatment depends on the symptomatology and degree of obstruction.

Cite This Article:

References :