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Background
Upper ureteral polyp is an unusual cause of hydronephrosis in children and a rare benign neoplasm of mesodermal origin. 1 2 The association of the two lesions-antenatally diagnosed moderate hydronephrosis improving on conservative management later getting complicated by upper ureteral polyp in the same patient is an extreme rarity. Only two similar cases have been reported in the literature. 1 2 We present our initial experience with upper ureteral polyp in the scenario of a background antenatally diagnosed hydronephrosis leading to delay in diagnosis and referral to an international centre.
Case presentation
A 7-year-old boy was diagnosed with right-sided congenital hydronephrosis during pregnancy and was followed up with serial periodic postnatal scans at every 6 months period. He was asymptomatic up to the age 6 years with the anteroposterior (AP) diameter of the right renal pelvis fluctuating between 7 and 15 mm and equal renal function with prompt drainage on MAG3 scans.
He developed episodic recurrent acute right loin pain and vomiting similar to Dietl's crisis which happened 10 times in the past 12 months.
He was seen by several professionals and had several admissions and investigations electively when the pain had settled down and did not show any gross abnormality other than the background right congenital fluctuating hydronephrosis.
His parents wanted further investigations of his recurrent problem. The boy was advised against swimming lessons as his problem was getting worse after swimming. Health professionals labelled the patient's mother to be a hypochondriac bordering on Munchausen syndrome by proxy and the patient was thought to have psychological problems of abdominal migraine or cyclical vomiting rather than any organic cause.
Investigations
The parents decided to get an international expert second opinion as the boy was clinically asymptomatic. Ultrasound scan showed right renal pelvis dilation measuring 5-6 mm only. Colour Doppler scan showed no evidence of any crossing lower polar vessels ( figure 1 A,B). MAG3 scan confirmed both kidneys to be functioning well and equally. After administration of furosemide, an evidence of slower drainage on the right side with dilation of upper right ureter and suggestion of an irregular filling defect partially obstructing the right upper ureter was evident ( figure 2 ).
During the next episode, an urgent ultrasound scan demonstrated an increase in...