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Dietl's crisis: a syndrome of episodic abdominal pain of urologic origin that may present to a gastroenterologist.

Publication ,  Journal Article
Mergener, K; Weinerth, JL; Baillie, J
Published in: Am J Gastroenterol
December 1997

A 53-yr-old woman presented with a 2-yr history of recurrent episodes of severe abdominal pain and nausea. Multiple investigations by a general surgeon, a urologist, and a gastroenterologist failed to identify the cause. She was referred to our Biliary Service for ERCP and sphincter of Oddi manometry. However, a detailed history was inconsistent with biliary pain, and the patient, having discussed the risks and benefits, elected not to proceed with ERCP. The patient was asked to come to the hospital during an acute attack of her pain for assessment. When this was done, transabdominal ultrasound revealed right hydronephrosis; intravenous urography showed obstruction at the level of the ureteropelvic junction, consistent with the presence of an aberrant artery. The syndrome of episodic abdominal pain and hydronephrosis caused by extrinsic pressure from such an artery is known as Dietl's crisis. In our patient, the diagnosis was confirmed at surgery, when the ureteric obstruction was dealt with by pyeloplasty. She made an uneventful recovery and remains asymptomatic 12 months later. The keys to diagnosing Dietl's crisis are awareness of the entity, taking a detailed pain history, and timely cross-sectional abdominal imaging during an attack.

Duke Scholars

Published In

Am J Gastroenterol

ISSN

0002-9270

Publication Date

December 1997

Volume

92

Issue

12

Start / End Page

2289 / 2291

Location

United States

Related Subject Headings

  • Urography
  • Ureteral Obstruction
  • Ureter
  • Ultrasonography
  • Syndrome
  • Recurrence
  • Nausea
  • Middle Aged
  • Kidney Pelvis
  • Kidney
 

Citation

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ICMJE
MLA
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Mergener, K., Weinerth, J. L., & Baillie, J. (1997). Dietl's crisis: a syndrome of episodic abdominal pain of urologic origin that may present to a gastroenterologist. Am J Gastroenterol, 92(12), 2289–2291.
Mergener, K., J. L. Weinerth, and J. Baillie. “Dietl's crisis: a syndrome of episodic abdominal pain of urologic origin that may present to a gastroenterologist.Am J Gastroenterol 92, no. 12 (December 1997): 2289–91.
Mergener K, Weinerth JL, Baillie J. Dietl's crisis: a syndrome of episodic abdominal pain of urologic origin that may present to a gastroenterologist. Am J Gastroenterol. 1997 Dec;92(12):2289–91.
Mergener, K., et al. “Dietl's crisis: a syndrome of episodic abdominal pain of urologic origin that may present to a gastroenterologist.Am J Gastroenterol, vol. 92, no. 12, Dec. 1997, pp. 2289–91.
Mergener K, Weinerth JL, Baillie J. Dietl's crisis: a syndrome of episodic abdominal pain of urologic origin that may present to a gastroenterologist. Am J Gastroenterol. 1997 Dec;92(12):2289–2291.
Journal cover image

Published In

Am J Gastroenterol

ISSN

0002-9270

Publication Date

December 1997

Volume

92

Issue

12

Start / End Page

2289 / 2291

Location

United States

Related Subject Headings

  • Urography
  • Ureteral Obstruction
  • Ureter
  • Ultrasonography
  • Syndrome
  • Recurrence
  • Nausea
  • Middle Aged
  • Kidney Pelvis
  • Kidney