Background and Objectives: Giant hydronephrosis refers to a hugely dilated kidney containing more than 1 L of fluid. It is usually due to congenital pelvi-ureteral junction obstruction in children. In adults, however, urolithiasis is the main cause and may result in bilateral conditions mimicking ascites. We aimed to present a case of bilateral giant hydronephrosis causing huge abdominal distention.
Case Report: A 73-year-old male patient presented with diffuse abdominal pain and distention. His abdomen was massively distended with pendulous and irregular contour. Bilateral renal masses were expected due to the smooth surface and cystic consistency. Urine analysis showed 40-70 pus cells/HPF and serum creatinine level was 3.4 mg/dl. Abdominal ultrasonography revealed hugely dilated kidneys with lost renal parenchyma due to bilateral ureteral stones. Bilateral nephrostomy tubes were inserted under local anesthesia with gradual drainage and produced 4.8 L and 5.2 L from the right and left kidneys, respectively. After improvement of serum creatinine and hemoglobin values, ureteral stones were treated endoscopically. Follow up ultrasonography showed decompressed kidneys and serum creatinine around 2 mg/dl.
Conclusion: Bilateral giant hydronephrosis is a cause of massive abdominal distention. It could be promptly diagnosed by ultrasonography. Initial percutaneous nephrostomy is recommended to save any potential residual functions.