|Year : 2000 | Volume
| Issue : 2 | Page : 156-157
An unusual medially directed calyceal diverticulum
Pankaj N Maheshwari, Mukund G Andankar, Deepak Jhangiani, Manish Bansal
R.G. Stone Urological Research Institute, Mumbai, India
Pankaj N Maheshwari
R.G. Stone Urological Research Institute, 14-A road, Khar (W), Mumbai - 400 052
Keywords: Calyces; Diverticulum.
|How to cite this article:|
Maheshwari PN, Andankar MG, Jhangiani D, Bansal M. An unusual medially directed calyceal diverticulum. Indian J Urol 2000;16:156-7
| Introduction|| |
A calyceal diverticulum is a smooth-walled intrarenal sac lined by non-secretary transitional epithelium that communicates with the pelvicalyceal system by means of a narrow neck. Diverticula usually arise from the calyceal fornix and most often affect the upper pole.  They may be multiple, and are usually laterally placed. The diagnosis is established by demonstrating a narrow neck leading from a calyceal fornix to the diverticular pouch.  Here we present an unusual case of a calyceal diverticulum arising from the lower calyceal fornix that was directed medially and cranially.
We have reviewed the literature and have failed to find any reported case of a medially directed calyceal diverticulum. It is because of this rarity that this case is presented.
| Case Report|| |
ABJ a 36-year male presented with left flank pain and recurrent urinary tract infection of 2 years duration. There were no positive findings on examination and renal parameters were normal. Ultrasonography revealed 3 small calculi in lower part of the collecting system of left kidney.
IVU showed the calculi to be present in a 1 x 1-cm calyceal diverticulum [Figure 1],[Figure 2]. This diverticulum arose from lower calyx and was directed postero-medially and cranially towards the renal hilum. In view of his pain, repeated infections and calculi, a decision of percutaneous nephrolithotomy was taken. The unusual direction of the calyceal diverticulum was further confirmed on a retrograde pyelography done prior to the percutaneous nephrolithotomy.
| Comment|| |
The etiology of calyceal diverticulum may by congenital or acquired. It is thought to be congenital because the incidence of this entity is equal in children and adults. The proposed embryological mechanism is that, at the 5mm stage of the embryo, some of the third and fourth generation ureteral branches, which normally degenerate, may persist. As this division occurs more rapidly at the poles and to the periphery, the diverticula are more frequent at the poles and are laterally oriented. 
The case presented here is unusual, as it is the only case we came across in review of literature which had a medially directed calyceal diverticulum.
| References|| |
|1.||Glassberg K1. Renal dysplasia and cystic disease of the kidney. In Campbell's Urology 7th edn. Philadelphia, Saunders. 1998: 2: 1757 1813. |
|2.||Marc P. Banner. Causes of upper urinary tract urolithiasis and medullary nephrocalcinosis. In Clinical Urography. Philadelphia.Saunders 1990: 2:1776-1804. |
|3.||Wulfsohn MA. Pylocaliceal diverticula J Urol 1980: 123:1-8. |
[Figure 1], [Figure 2]