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J Indian Assoc Pediatr Surg. 2018 Oct-Dec;23(4):236-238. doi: 10.4103/jiaps.JIAPS_139_18.

An Enigmatic Route to the Contralateral Pelvicalyceal System on Antegrade Pyelogram.

Author information

1
Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
2
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.

Abstract

Introduction:

The authors present the rare yet enigmatic phenomenon of 'pyelo-renal' backflow.

Case Presentation:

An eight-month-old boy with multiple congenital anomalies underwent left Anderson-Hynes Pyeloplasty for pelvi-ureteric junction obstruction. Antegrade dye-study done through the nephrostomy revealed obstruction at the level of the pelvi-ureteric junction, yet the contrast was visualized in the pelvis of contralateral kidney and urinary bladder (pyelo-venous backflow) masquerading as vesicoureteric reflux. The phenomenon of 'pyelo-renal' backflow along with pyelo-tubular, pyelo-interstitial, pyelo-sinusal and pyelo-lymphatic backflow have been described and the respective mechanisms discussed.

Conclusion:

The phenomenon is known to happen in the presence of obstruction to outflow from renal pelvis thereby creating a closed compartment. Injection of contrast at a pressure above the critical limit may result in forniceal tears and back-flow of contrast into the renal tubules and beyond.

KEYWORDS:

Pyelocanalicular backflow; pyelointerstitial backflow; pyelolymphatic backflow; pyelosinus backflow; pyelosinusal backflow; pyelotubular backflow; pyelovenous backflow

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