Retro-Iliac Ureter: A Case Report of an Unusual Cause of Mid-ureteric Obstruction

TL;DR

A 27-year-old woman with a rare congenital condition had a successful surgery to fix a ureter that ran behind her iliac vessels, causing blockage and infections.

Contribution

This is the first reported case combining retro-iliac ureter with Mayer-Rokitansky-Küster-Hauser syndrome.

Findings

Retro-iliac ureter was diagnosed via intraoperative retrograde pyelogram and surgical exploration.

The patient's symptoms were resolved through anterior transposition and anastomosis of the ureter.

The case highlights the rarity and management challenges of this combined congenital anomaly.

Abstract

Retro-iliac ureter, a rare congenital anomaly in which the ureter courses behind the iliac vessels, is infrequently reported in the urological literature. We describe the case of a 27-year-old woman with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome type II who presented with recurrent urinary tract infections (UTIs) and persistent right flank pain. Intraoperative retrograde pyelogram (RGP) demonstrated a markedly dilated right ureter with contrast hold-up near the sacroiliac joint. Surgical exploration confirmed a retro-iliac course of the ureter. The patient underwent successful anterior transposition and anastomosis of the ureter. This case illustrates the diagnostic challenges and surgical management of the retro-iliac ureter, particularly when associated with complex congenital anomalies such as MRKH syndrome. To our knowledge, this may be the first reported case of these two rare anomalies being combined.

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