Introduction

Giant hydronephrosis is usually caused by congenital pelviureteric junction obstruction (PUJ). Impacted stones at PUJ₂ and ureterovesical junction₃ obstruction have also been reported as causes for giant hydronephrosis.

Case Report

A 23 year old man presented with diffuse progressive distension of the abdomen for the past ten years with exceptional dyspnoea. Paracentesis was done on three occasions and he had transient relief of symptoms. On examination there was diffuse distention of the abdomen with fluid thrill. Cardiovascular system was clinically normal.

Renal and liver functions were normal. Computed Tomography (Fig.1) of the abdomen revealed a huge cystic mass occupying the abdomen displacing the bowel to the right. Left kidney could not be visualized. An isotope study revealed a photopenic area in the left renal bed with no tracer uptake at three and half hours. Left subcostal exploration revealed a massive hydronephrotic kidney containing 22 liters of urine with PUJ obstruction. A left nephrectomy was done and he had symptomatic relief. A biopsy confirmed the clinical diagnosis of PUJ obstruction with evidence of chronic pyelonephritis. In poorly functioning hydronephrotic kidneys or with pyonephrosis the treatment of choice is nephrectomy. If the kidney is salvageable reconstructive procedures like pyeloplasty, calicovesicostomy₄ and Boari flap calico vesicostomy₅ can be done. Nephrectomy was done for our patient, as the kidney was nonfunctioning.

Figure 1

Figure 1: Huge cystic mass on a CT scan displacing the bowel.

Conclusion

Giant hydronephrosis presenting as a large abdominal mass mimicking ascites is a rare entity. Erroneous treatment can lead to persistence of symptoms, pyonephrosis and septicemia.

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