Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 41  |  Issue : 2  |  Page : 133-135

Symptomatic calyceal diverticulum: A case report


1 Department of Urology, KLES Kidney Foundation, KLE University's Jawaharlal Nehru Medical College, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum, Karnataka, India
2 Department of Biotechnology and Microbiology, Karnatak University, Dharwad, Karnataka, India

Date of Web Publication20-May-2014

Correspondence Address:
R. B. Nerli
Department of Urology, KLES Kidney Foundation, KLE University's Jawaharlal Nehru Medical College, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum - 590 010, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-5009.132863

Rights and Permissions
  Abstract 

Calyceal diverticula are rare and unusual lesions in children. We report a case of symptomatic lesion in a 13-year-old male child presenting with pain and recurrent episodes of infection.

Keywords: Calyceal diverticulum, hematuria, infection, symptomatic lesion


How to cite this article:
Nerli RB, Patil NA, Abhijith SM, Hiremath MB. Symptomatic calyceal diverticulum: A case report. J Sci Soc 2014;41:133-5

How to cite this URL:
Nerli RB, Patil NA, Abhijith SM, Hiremath MB. Symptomatic calyceal diverticulum: A case report. J Sci Soc [serial online] 2014 [cited 2020 Aug 9];41:133-5. Available from: http://www.jscisociety.com/text.asp?2014/41/2/133/132863


  Introduction Top


A calyceal diverticulum is a cystic cavity within the kidney that is lined by transitional epithelium and communicates with a calyx or less commonly with the renal pelvis through a narrow isthmus. [1],[2] Calyceal diverticulum was first described by Rayer in 1841. [1] The upper calyx is the one that is most affected (70%). [3],[4] They arise frequently from the posterior aspect of the kidney and are usually unilateral. [4] Most cysts are small <1 cm; however, larger ones are occasionally detected. [4]

Calyceal diverticula are usually asymptomatic; however, they can become problematic at times. [3] These diverticula are known to be associated with flank pain, hematuria, recurrent urinary tract infections (UTIs), and calculus formation. We report a case of symptomatic calyceal diverticula in a child.


  Case report Top


A 13-year-old male child presented with history of right flank pain and recurrent episodes of fever with chills. Physical examination revealed no significant findings. Urine examination revealed pyuria and bacteriuria. Ultrasonography examination revealed a right-sided upper polar cystic lesion, 2.5 cm in size. Intravenous urogram revealed the cystic lesion communicating with the collecting system. Computed tomography confirmed the cystic lesion [Figure 1]. Voiding cystourethrogram revealed no reflux. Under antibiotic cover, retrograde urethrogram was done, which showed contrast filling the cystic lesion [Figure 2], but the exact position of the diverticular opening was not identified. Flexible ureteroscopy was done using an 8 Fr flexible ureteroscope. The upper calyx was well visualized, but the mouth of diverticulum could not be identified. In view of recurrent episodes of UTI, the child was surgically explored and the diverticulum was excised along with a portion of surrounding renal parenchyma. Postoperatively, the child had an uneventful recovery.
Figure 1: Computed tomogram showing right upper pole calyceal diverticulum

Click here to view
Figure 2: Retrograde pyelogram showing gradually filling calyceal diverticulum

Click here to view



  Discussion Top


Calyceal diverticulum is an unusual, rare lesion of uncertain etiology, in which an urine-filled cavity lined with nonsecreting transitional epithelium, is connected to the renal calyx or the pelvis by a narrow or stenotic isthmus. [4] The incidence is about 0.21%-0.45% based on accidental findings on intravenous urogram [3],[4],[5],[6] and characteristically appears as a contrast-filled cystic cavity. Opacification and washout of contrast from the diverticulum may be delayed because of a slow exchange of urine between the collecting system and the diverticulum. [7] Sometimes the diverticulum may fail to opacify due to occlusion of the neck from infection. Urographically, two varieties of diverticulum are described. Type I is situated at the upper pole and communicates with the calyceal cup, usually at the fornix. These lesions have a bulbous shape with a narrow connecting infundibulum. Type II diverticula communicate with the renal pelvis and may become large enough to produce mass effect. The neck is short and not easily identified. [8]

Most calyceal diverticula are asymptomatic. Recurrent UTIs will be identified in 25% of the patients and poor drainage can result in sepsis, abscess formation, and eventual parenchymal damage. [3] Calculi can occur in 9.5%-50% of these diverticula. [3] These calculi are retained due to the small caliber of the diverticular necks. Asymptomatic diverticula can be managed expectantly. Indications for intervention include pain, recurrent UTIs, stones, compression, and damage of surrounding parenchyma.

Treatment includes invasive, open surgical techniques such as unroofing and marsupialization procedures, diverticulectomy or partial nephrectomy. The operative goals are obliteration of the diverticulum and communicating channel and, if present, complete clearance of calculi. Other surgical procedures include percutaneous ablation, laparoscopic marsupialization/ablation, and ureteroscopic infundibuloplasty with possible lithotripsy. [2]

Estrada et al., [2] reviewed their series of calyceal diverticula in 22 children with a mean age of 5.4 ± 3.1 years. A total of 10 children presented with febrile UTI, 2 had hematuria, 2 had abdominal pain, 1 had flank pain, and 8 were asymptomatic. The mean diameter was 2.2 ± 1.7 cm. Two children (9%) had concomitant ipsilateral calyceal diverticula and vesico ureteric reflux. A total of 10 children were treated at a mean age of 3.0 ± 2.3 years. Treatment modalities included percutaneous ablation, open marsupialization/ablation, partial nephrectomy, and laparoscopic marsupialization/ablation. There were no recurrences during the follow-up period. The authors concluded that calyceal diverticula are rare in children. Most are stable and asymptomatic. Approximately, 20% have symptomatic enlargement warranting surgical intervention. Overall, approximately 43% require surgical intervention.


  Conclusion Top


Calyceal diverticula are rare and unusual lesions in children. If symptomatic, these lesions are a source of morbidity requiring surgical intervention.


  Acknowledgment Top


KLES Kidney Foundation, Belgaum.

 
  References Top

1.Shapiro E, Bauer SB, Chow JS. Anomalies of the upper urinary tract. In: Campbell-Walsh, editor. Urology. 10 th ed. Philadelphia: Elsevier-Saunders; 2012. p. 3153-4.  Back to cited text no. 1
    
2.Estrada CR, Datta S, Schneck FX, Bauer SB, Peters CA, Retik AB. Caliceal diverticula in children: Natural history and management. J Urol 2009;181:1306-11.  Back to cited text no. 2
    
3.Mandeville JA, Gnessin E, Lingeman JE. Percutaneous management of calyceal diverticula: An American experience. In: Al-Khandari AM, editor. Difficult Cases in Endourology. London: Spinger-Verlag; 2013. p. 33.  Back to cited text no. 3
    
4.Kaviani A, Hosseini J, Lotfi B, Valipour R, Sadeghain I. Disfiguring abdominal mass due to a huge extraordinary calyceal diverticulum. Urol J 2010;7:284-6.  Back to cited text no. 4
    
5.Wolf JS Jr. Calyceal diverticulum and hydrocalyx: Laparoscopic management. Urol Clin North Am 2000;27:655-60.  Back to cited text no. 5
[PUBMED]    
6.Wulfsohn MA. Pyelocalyceal diverticula. J Urol 1980;123:1-8.  Back to cited text no. 6
[PUBMED]    
7.Jain M, Grover SB, Kumar A, Mohanty NK. Images: Pyelocalyceal diverticulum. Ind J Rad Img 2004;14:279-81.  Back to cited text no. 7
    
8.Davidson AJ, Hartman DS, Choyke PL, Wagner BJ. Davidson′s Radiology of the Kidneys and Genitourinary Tract. 3 rd ed. Philadelphia: Saunders; 1999. p. 416-21.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case report
Discussion
Conclusion
Acknowledgment
References
Article Figures

 Article Access Statistics
    Viewed7075    
    Printed52    
    Emailed0    
    PDF Downloaded270    
    Comments [Add]    

Recommend this journal