Diagnostic Dilemma and Surgical Management of Circumcaval Ureter: A Case Report.

Circumcaval ureter (CVU) is an uncommon congenital anomaly, in which the proximal ureter makes a loop posterior to the inferior vena cava (IVC) usually resulting in ureteric obstruction with consequential hydronephrosis and a right nonfunctioning kidney. It is also called a retrocaval or postcaval ureter. CVU is rarely encountered and, hence, may pose a diagnostic dilemma for radiologists and urologists. Clinical presentation occurs in the 3rd and 4th decades of life, manifesting mainly with flank pain. We present our experience in the diagnosis and management of CVU in a Nigerian Centre. A 56-year-old man presented with a 2-year history of recurrent, colicky right flank pain. He had been seen in multiple tertiary hospitals with no definitive diagnosis or treatment. A computerised tomography urogram showed an abnormally dilated proximal ureter with the classical fish-hook appearance and medial displacement, posterior to the IVC. At surgery, via an open, flank, extraperitoneal approach a CVU was found with significant stenosis and prestenotic dilatation. An excision of the stenotic segment with ureteroureterostomy was performed over a 6F D-J stent, and he had a smooth postoperative period. A CVU is extremely rare, and hence, the diagnosis can be missed. If left unattended, CVUs can progress to hydronephrosis and, eventually, a nonfunctioning right kidney. A high index of suspicion and early surgical intervention are key to a successful outcome.

Impact of COVID-19 on renal replacement therapy: perspective from a Nigerian renal transplant centre.

Introduction: COVID-19 has had a huge impact on the health system and the world at large. Patients with kidney failure are a select group which have been affected significantly by the scourge of the disease. In the COVID-19 era, renal replacement therapy (RRT) in the form of dialysis and kidney transplantation required modifications in many centres in order to maintain high quality care and reduce infection rates among this susceptible group of patients. The objectives were to describe some of the challenges experienced in one of the leading renal care centres in Nigeria during the height of the COVID-19 pandemic and analyse the impact of practice changes on select outcomes. Methods: a retrospective cross-sectional review of haemodialysis activities and kidney transplantation among chronic kidney disease patients was done over a 15-month period ranging from April, 2019 to June, 2021. Data was extracted from the electronic media record (EMR) and analysed using SPSS version 22. Results: there was an initial significant drop in the number of haemodialysis sessions and kidney transplant surgeries by 16.7% and 66% respectively in the first 2 months of COVID-19 in our centre following the national lockdown. The mean monthly kidney transplant rate was 9±3.29 before the COVID-19 and the national lockdown, this figure reduced to 3.0±0.1 during the lockdown. Activities however normalized at 6 months following the initial lockdowns have remarkable exceeded pre-COVID numbers as at early 2021. Conclusion: after the initial drop in numbers of patients for haemodialysis and renal transplantation, there was an increase in numbers in the following months. It was instructive to put several steps in place in order to continue to offer high level RRT in the COVID-19 pandemic. RRT can safely be practiced in the COVID-19 pandemic.

Congenital bilateral iliac vein anomalies in a Nigerian pediatric kidney transplant recipient: A case report and literature review.

The finding of bilateral congenital common iliac vein anomalies is indeed uncommon. This article presents the case of an 11-year-old boy with end-stage renal disease who had kidney transplantation (KT). At presentation, he was found to have a large superficial vein running from the left groin over the suprapubic area. The arterial pulsation of both lower limbs was preserved, and there was no pedal edema. Contrast-enhanced computed tomography scan revealed aplasia of the right common iliac vein, stenosis of the left common iliac vein, and marked dilatation of the left external and internal iliac veins. There were also varicosity of numerous pelvic veins and a collateral vein draining the right lower limb. This preoperative diagnosis was key to planning for surgery. On KT surgery, the renal allograft vein was anastomosed in an end-to-side fashion to the inferior vena cava and artery to the common iliac artery. The patient had a smooth postoperative recovery and continues to enjoy a normal renal function.

Résumé La découverte d'anomalies bilatérales congénitales de la veine iliaque commune est en effet rare. Cet article présente le cas d'un garçon de 11 ans avec insuffisance rénale terminale ayant subi une transplantation rénale (KT). Lors de la présentation, il a été découvert qu'il avait une grosse veine superficielle s'écoulant de l'aine gauche sur la zone sous-pubienne. La pulsation artérielle des deux membres inférieurs a été préservée et il n'y avait pas d'œdème pédale. La tomodensitométrie avec du contrast a révélé une aplasie de la veine iliaque commune droite, une sténose de la veine iliaque commune gauche et une dilatation marquée des veines iliaques externes et internes gauches. Il y avait aussi une varicosité de nombreuses veines pelviennes et une veine collatérale drainant la membre inférieure droite. Ce diagnostic préopératoire était essentiel à la planification de la chirurgie. Lors de la chirurgie KT, la veine d'allogreffe rénale a été anastomosée dans un mode à la veine cave inférieure et artère à l'artère iliaque commune. Le patient a eu une récupération postopératoire en douceur et continue de profiter d'une fonction rénale normale. Mots clés: Aplasie de la veine iliaque, Congénitale, Greffe de rein, Nigéria, Pédiatrique.

Bellini duct carcinoma of the kidney masquerading as an iliac bone tumour in an adult Nigerian.

Bellini Duct Carcinoma (BDC) of the Kidney is a rare type of Renal Cell Carcinoma. It usually presents with features of local advancement or metastasis and rarely diagnosed incidentally. We present a case report of a young man who was found to have BDC of the Right Kidney following presentation with an iliac bone tumour. A 40 year old man presented to the Orthopaedic outpatient clinic on account of right sided pelvic pain and limping following a trivial fall at home. There was no antecedent history of loin pain, loin mass or haematuria. On evaluation, he was found to have a huge right iliac bone tumour invading the contiguous muscles. An incidental hypodense central ipsilateral renal mass with enlarged peri-hilar lymph nodes were found. He subsequently had right radical nephrectomy via a right sub-coastal approach and wide local excision of the Iliac bone tumour in two separate procedures. The resection margins were negative for tumour cells. Histology of the resected specimens were consistent with a metastatic right BDC of the kidney. He had a smooth post-operative recovery. One third of BDC of the kidney presents with metastasis. A high index of suspicion is required in order to diagnose BDC following such unusual presentations.