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CASE REPORT
Bilateral ureteric obstruction during in vitro fertilisation therapy in a patient with complex surgically managed Crohn's disease
  1. Christopher Charles Khoo1,
  2. Nikhil Ahluwalia1,
  3. Jan Grace2,
  4. Arun Sahai1
  1. 1Department of Urology, Guy's and Saint Thomas’ NHS Foundation Trust, London, UK
  2. 2Assisted Conception Unit, Guy's and Saint Thomas’ NHS Foundation Trust, London, UK
  1. Correspondence to Dr Christopher Charles Khoo, christopher.khoo{at}nhs.net

Summary

A 37-year-old woman receiving in vitro fertilisation (IVF) treatment presented with lethargy, fevers and anuria. Her background included complex surgically managed Crohn's disease and mild right-sided hydronephrosis (with no evidence of obstruction on MAG3 renogram). On examination, she had a distended abdomen with generalised tenderness. Blood tests revealed an acute kidney injury and confirmed sepsis. She was found to have bilateral ureteric obstruction with worsening of the right-sided hydronephrosis and new-onset left-sided hydronephrosis secondary to bilateral ovarian masses, diagnosed as mild ovarian hyperstimulation syndrome (OHSS). She was initially managed with fluid resuscitation, bilateral nephrostomies, antibiotics and supportive management of mild OHSS. She made a good recovery and was discharged after placement of antegrade stents and removal of nephrostomies. On follow-up, following resolution of ovarian hyperstimulation, she has been diagnosed with a right-sided distal ureteric stricture and is awaiting reconstruction. Her left ureteric stent has been removed.

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Footnotes

  • Contributors CCK and NA researched the literature. CCK wrote the first draft of the manuscript. JG, AS and CCK further researched and revised the manuscript. All authors reviewed and edited the manuscript and approved the final version.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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