# Right retrocaval ureter associated with asymptomatic left retro aortic renal vein: A case report

## TL;DR

A 9-year-old boy with a rare right retrocaval ureter and asymptomatic left retroaortic renal vein underwent successful open surgery to resolve urinary obstruction.

## Contribution

This case report highlights the coexistence of two rare vascular anomalies and their successful surgical management in a pediatric patient.

## Key findings

- A 9-year-old boy presented with retrocaval ureter and left retroaortic renal vein, diagnosed via imaging.
- Surgical correction via open uretero-ureteral anastomosis resolved hydronephrosis and led to full recovery.
- The case underscores the importance of considering rare vascular anomalies in pediatric urinary obstruction.

## Abstract

Retrocaval ureter is a rare congenital abnormality resulting from abnormal development of the inferior vena cava (IVC), leading to compression and obstruction of the right ureter. The condition is frequently diagnosed incidentally or presents symptoms related to hydronephrosis. The left retroaortic renal vein is another vascular anomaly with an estimated prevalence of 1.7 % to 3.4 %. However, it is typically asymptomatic.

We present the case of a 9-year-old boy with a history of undescended right testis and hypospadias who presented with intermittent pain and hematuria. Physical examination revealed mild tenderness of the renal angle. Imaging studies, including ultrasound and uroscan, demonstrated right hydronephrosis, an S-shaped deformity of the proximal right ureter, and a medium calyceal stone. Interestingly, a left retroaortic renal vein was also identified. The patient underwent surgical correction using a conventional open approach, where the retrocaval segment was excised, excised, and an end-to-end uretero-ureteral anastomosis was performed on a double J stent. Postoperative recovery was uneventful and uneventful and follow-up imaging showed resolution of hydronephrosis.

Retrocaval ureter is a developmental anomaly with an estimated prevalence of 0.13 %. It often presents urinary obstruction and recurrent infections. The diagnosis is based on imaging modalities, including 3D reconstruction CT urography. Treatment is recommended for symptomatic cases to prevent long-term renal deterioration. Surgical options include open, laparoscopic, and robotic approaches. In our case, conventional surgery was chosen due to the available anatomy and surgical expertise.

Congenital anomalies of the IVC and renal veins, although rare, should be considered in paediatric patients with urinary compression. Advances in imaging have improved the diagnosis of these anomalies, allowing for timely and effective surgical management.

•Retrocaval ureter, a rare developmental defect of the inferior vena cava, can cause ureteral compression and hydronephrosis.•A 9-year-old boy with a history of undescended testis and hypospadias presented with flank pain and hematuria; imaging revealed an "S"-shaped ureter and hydronephrosis.•The patient underwent open surgical correction with ureteral anastomosis and a double-J stent, leading to full recovery.

Retrocaval ureter, a rare developmental defect of the inferior vena cava, can cause ureteral compression and hydronephrosis.

A 9-year-old boy with a history of undescended testis and hypospadias presented with flank pain and hematuria; imaging revealed an "S"-shaped ureter and hydronephrosis.

The patient underwent open surgical correction with ureteral anastomosis and a double-J stent, leading to full recovery.