Secondary obstructive giant megaureter leading to massive py
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A 70-year-old female presented with right back pain and fever. Six months earlier was submitted to hysterectomy and bilateral salpingo-oophorectomy for an ovarian epithelial cancer (stage IA). On physical examination, she had chills, fever, and tenderness at the right costovertebral angle. Blood tests indicated acute renal failure and marked elevation of C-reactive protein. In renal ultrasound, a mild right hydronephrosis was identified, and the respective ureter proved to be impossible to visualize due to the presence of a large cystic-like structure. As there was a suspicion of obstructive pyelonephritis, a renal scintigraphy was performed indicating the presence of a significant unilateral obstruction. Non-contrast computed tomography (CT) scan showed a markedly distended right ureter (up to 9.5 cm in diameter) with tortuosity and not evident in previous follow-up CT scan. No calculus or other anatomical urologic abnormalities were found. The patient underwent percutaneous nephrostomy, which drained 1500 cc of purulent fluid. Escherichia coli were isolated and adequate antibiotic therapy was instituted. The clinical condition of the patient declined progressively and had passed away after three days.

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