Giant Hydronephosis of the Upper System on Pyelo-ureteral Duplicity

Hydronephrosis with duplicity of the excretory tracts is a rare condition; it is often associated with either junction syndrome or vesicoureteral reflux. We present the case of a 66-year-old patient with no significant medical history admitted to the emergency room complaining of a painful abdominal distension in a feverish context. Clinical examination objectified a fever at 38.7, abdominal asymmetry with percussion dullness and a painful hot mass, occupying the entire right part of the abdomen, from the right hypochondrium to the hypogastrium. The biological exam showed leucocytes at 10900, CRP at 255, blood creatinine at 15mg/l, urine culture was sterile. First line abdominal ultrasound objectified a 28 cm cystic mass that extends from the right renal compartment to the hypogastric compartment. The CT urography showed huge uretero- pyelocaliceal dilation with duplex system compressing the renal parenchyma and the above and underlying parameters with a pylon measured at 30 cm [Figure 1]. The patient underwent a percutaneous drainage by a nephrostomy under antibiotic cover with good clinical and biological evolution, then a partial upper system nephrectomy was performed in a second time.