Very late diagnosed Retrocaval ureter: A case report of a very rare entity in Cameroon, sub-Sahara Africa

Introduction and importance: Retrocaval ureter (RCU) is a rare congenital anomaly usually associated with upper urinary tract stasis, in which the ureter itself passes behind the inferior vena cava. RCU is often misdiagnosed and can lead to serious complications related to the upper urinary tract stasis. Case presentation: We report the case of a 57-year-old female who presented with 1-year history of intermittent right flank pain, of gradual onset. She was diagnosed with right RCU, with advanced functional deterioration of the kidney, managed by nephrectomy. The postoperative course was uneventful. Clinical discussion: RCU results in varying degrees of hydronephrosis and thus, in a non-specific clinical presentation. Most cases are asymptomatic, discovered only during imaging or surgery for unrelated conditions or at autopsy. A late diagnosis can lead to an obstructive nephropathy which can be very harmful to the kidney. Conclusion: RCU is a very rare entity. The diagnosis can sometimes be late in under-medicalized settings, and must be taken into consideration in front of any hydronephrosis associated or not with intermittent flank pain. RCU-related complications can be very serious. Fish hook sign may be absent in case of nonfunctional kidney and must not exclude the diagnosis. Emphasis should be placed on prenatal diagnosis and routine abdominal ultrasound for early detection.