Giant hydronephrosis: a rare cause of gross abdominal distension.

A 53-year old man was admitted with painless progressive abdominal distension of 1 year duration. He was a lorry driver and his abdomen started touching the steering wheel, making his job difficult. The abdominal distension was increasing despite treatment for “presumed” ascites. Clinical examination revealed a symmetrically distended abdomen with no palpable masses (Figure1). The swelling was dull to percussion and a fluid thrill could be elicited. But there was no shifting dullness. Ultrasonography revealed a cystic lesion occupying the entire abdomen and pelvis. The left kidney was not visualised. A CT scan showed a large cystic lesion with a normally functioning right kidney (Figure 2). Absence of fluid in the subhepatic space excluded ascites. At laparotomy, a giant hydronephrotic left kidney with a normal calibre ureter was found. Decompression of the kidney yielded 23 litres of dark grey fluid. A left Giant hydronephrosis : a rare cause of gross abdominal distension