A 36-year-old patient with no relevant personal history except for two cesarean sections was referred to our service due to pain in the right renal fossa.
A plain abdominal radiograph showed a right renal lithiasis and an intravenous urography showed a right ureter ligation in its upper third without other significant findings.
Asymptomatic, the patient was discharged.
Two months later, the patient was admitted again to the same clinic and a new battery of tests. In the simple abdominal X-ray, the existence of a lithiasis at the level of the right distal ureter was confirmed, and the ultrasound found confirmed the right kidney obstructive.
Laboratory tests are normal at all times.
Ureteral lithiasis was treated by means of endoscopy and lasertherapy. The symptoms persisted despite the efficacy of the treatment, which led to a new admission months later.
A right iliac crest ectasia was observed.
At CT, the kidneys are normal, but the right ureter is slightly dilated to the distal third where a 1.5 cm ovarian cyst is identified, which may be partially compressing the distal third of the ureter only.
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In the ascending pyelography, a ureteral stenosis was observed. A double J catheter was placed and removed 8 weeks later without showing any clinical improvement.
It was decided to do a nuclear magnetic resonance (NMR) that could provide some new data to justify the symptoms; this NMR reported a right ureteral ectasia due to a possible ovarian vein syndrome.
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The programme for surgery was ovarian vein ligation plus right surgery via transabdominal laparoscopy.
The patient was placed in mild left lateral decubitus.
Sickness located above the iliac crest with CO2 through a Veress needle and placement of a four-card (sick type), located between the iliac crest and the iliac crest (second iliac crest)
After the incision of the Toldt line and decolation, the identification of the lumbar ureter and its follow-up are performed until the passage between the iliac artery and the ovarian vein is observed, the last branch of the ureter acts above.
The ovarian vein is released and then ligated and sectioned.
Finally, we performed a Redon drainage without aspiration through the lateral face mask. Hemostasis was confirmed, CO2 was placed and sutured at the ports of entry.
The postoperative course was uneventful and the patient was discharged on the second day after surgery.
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In subsequent revisions, at 3 and 6 months after surgery, the patient is completely asymptomatic and in the control VU there is ectasia and acoding of the right ureter.
