Indian Journal of Urology
CASE REPORT
Year
: 2000  |  Volume : 16  |  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

Correspondence Address:
Pankaj N Maheshwari
R.G. Stone Urological Research Institute, 14-A road, Khar (W), Mumbai - 400 052
India




How to cite this article:
Maheshwari PN, Andankar MG, Jhangiani D, Bansal M. An unusual medially directed calyceal diverticulum.Indian J Urol 2000;16:156-157


How to cite this URL:
Maheshwari PN, Andankar MG, Jhangiani D, Bansal M. An unusual medially directed calyceal diverticulum. Indian J Urol [serial online] 2000 [cited 2020 Jan 26 ];16:156-157
Available from: http://www.indianjurol.com/text.asp?2000/16/2/156/22219


Full Text

 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. [1] 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. [2] 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. [3]

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

1Glassberg K1. Renal dysplasia and cystic disease of the kidney. In Campbell's Urology 7th edn. Philadelphia, Saunders. 1998: 2: 1757­ 1813.
2Marc P. Banner. Causes of upper urinary tract urolithiasis and med­ullary nephrocalcinosis. In Clinical Urography. Philadelphia.Saunders 1990: 2:1776-1804.
3Wulfsohn MA. Pylocaliceal diverticula J Urol 1980: 123:1-8.