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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.

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



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.


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.


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

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