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An Image of Hutch Diverticulum with Ureteric Insertion
TJ01-TJ02
Correspondence
Senthil Kumar Aiyappan,
Professor and Head, Department of Radiodiagnosis, SRM Medical College Hospital and Research Centre, Kattankulathur, Chengalpattu-603203, Tamil Nadu, India.
E-mail: asenthilkumarpgi@gmail.com
A 38-year-old male patient presented with complaints of occasional right loin pain, dysuria, and suprapubic tenderness for three weeks. The patient had no history of haematuria. Upon examination, the patient was afebrile, and vitals were stable. Blood tests revealed mild neutrophilic leukocytosis, and urine tests revealed a few pus cells. Further radiological investigations were conducted. An initial ultrasound performed outside, one week earlier, showed a small-sized right kidney measuring 8 cm with cortical scars, raised cortical echoes, and ill-defined corticomedullary differentiation. A small outpouching was noted in the posterior wall of the urinary bladder, suggestive of a diverticulum. The patient underwent a Micturating Cystourethrogram (MCU) to rule out vesico-ureteric reflux. The MCU showed reflux of contrast from the bladder into the right ureter and pelvi-calyceal system without dilatation, suggestive of grade-II vesico-ureteric reflux on the right-side. However, the diverticulum could not be delineated on the MCU since it was small.
The urethra was normal with no evidence of urethral obstruction (Table/Fig 1)a,b. The patient then underwent a computed tomography scan immediately after the MCU, confirming a small-sized right kidney with cortical scarring (Table/Fig 2)a-d. Grade-II vesico-ureteric reflux was associated according to the international system of radiographic grading of vesico-ureteric reflux, along with a small diverticulum measuring approximately 9×8 mm in the right posterior wall of the urinary bladder close to the vesico-ureteric junction, with an opening of the right ureter into the diverticulum. The left kidney showed mild compensatory hypertrophy measuring 12 cm.
A diagnostic cystoscopy (Table/Fig 3) performed under general anaesthesia confirmed the presence of a diverticulum with the opening of the right ureter into the diverticulum. There were no signs of cystitis during cystoscopy. Since the patient was unwilling to undergo surgery or further investigations, it was decided to manage the patient conservatively with antibiotics, anti-spasmodics, and follow-up unless complications due to voiding dysfunction arise, necessitating surgical intervention.