Hydronephrosis and ureteral obstruction are rare
sequelae of Crohn’s disease. Chronic obstruction can ultimately lead to
dysfunction of the affected kidney, and atypical presenting symptoms create
pitfalls in diagnosis. Few reviews in the literature focus on this process and
are limited to isolated case reports and case reviews. We performed a PubMed
search using such terms as “Hydronephrosis” AND “Crohn’s disease” AND/OR
“ureteral obstruction.” References from selected papers were reviewed for
relevance and used for information-gathering as well. Ureteral obstruction most
commonly occurs on the right side, due to ileal involvement. Clinical diagnosis
is difficult, as symptoms are notably not genitourinary in origin; rather they
are more musculoskeletal in nature. Treatment centers on disease control and temporary
drainage of the affected kidney. Though rare, hydronephrosis and ureteral
obstruction may develop as a result of inflammatory bowel disease. Due to
atypical presenting symptoms, a high clinical suspicion is needed to affirm the
diagnosis and ensure proper treatment.
References
[1]
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[2]
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doi:10.3109/00365527709181328
[3]
H. Ben-Ami, Y. Ginesin, D. M. Behar, D. Fischer, Y. Edoute and A. Lavy, “Diagnosis and Treatment of Urinary Tract Complications in Crohn’s Disease: An Experience over 15 Years,” Canadian Journal of Gastroenterology, Vol. 16, No. 4, 2002, pp. 225-229.
[4]
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[5]
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[6]
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[7]
D. H. Present, J. G. Rabinowitz, P. A. Banks and H. D. Janowitz, “Obstructive Hydronephrosis. A Frequent but Seldom Recognized Complication of Granulomatous Disease of the Bowel,” The New England Journal of Medicine, Vol. 280, No. 10, 1969, pp. 523-528.
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[8]
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[9]
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[10]
A. Vecchioli, M. G. Brizi, A. De Franco, L. Natale and A. L. Valentini, “Hydroureteronephrosis in Crohn’s Disease,” Rays, Vol. 14, 1989, pp. 163-166.
[11]
A. J. Megibow, M. A. Bosniak, M. A. Ambos and P. E. Redmond, “Case Report. Crohn’s Disease Causing Hydronephrosis,” Journal of Computer Assisted Tomography, Vol. 5, No. 6, 1981, pp. 909-911.
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[12]
R. A. Mooney and G. R. Sant, “Obstructive Uropathy in Granulomatous Bowel Disease,” British Journal of Surgery, Vol. 60, No. 7, 1973, pp. 525-527.
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[13]
R. Kutcher, A. Rosenbaum and N. H. Messinger, “Isolated Left Hydronephrosis Complicating Ileocaecal Granulomatous Disease,” British Journal of Radiology, Vol. 47, No. 560, 1974, pp. 490-492.
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[14]
H. Ben-Ami, A. Lavy, D. M. Behar, Y. Ginesin, D. Fischer and Y. Edoute, “Left Hydronephrosis Caused by Crohn Disease Successfully Treated Conservatively,” The American Journal of the Medical Sciences, Vol. 320, No. 4, 2000, pp. 286-287.
doi:10.1097/00000441-200010000-00011
[15]
J. M. Siminovitch and V W. Fazio, “Ureteral Obstruction Secondary to Crohn’s Disease: A Need for Ureterolysis?” The American Journal of Surgery, Vol. 139, No. 1, 1980, pp. 95-98. doi:10.1016/0002-9610(80)90236-6
