Dietl's crisis: an under-recognized clinical entity in the pediatric population

Abstract

Objective: To characterize and determine whether patients with recurrent abdominal symptoms and associated ureteropelvic junction obstruction (UPJO) (Dietl's crisis) are effectively treated by pyeloplasty and to determine criteria for evaluating UPJO in childhood abdominal pain. Materials and Methods: A retrospective chart review from 1998 to 2001 was performed to identify patients with Dietl's crisis and associated UPJO. Chart review included presenting symptoms, location of lesion, condition of the affected renal unit, referral method, and surgery success. Results: Eight patients (7 male and 1 female) were identified with Dietl's crisis. All eight were initially misdiagnosed and spent at least a year with significant pain symptoms before being properly diagnosed. Only one patient had associated urologic complaints. Renal scan split functions of the affected renal unit ranged from 34% to 51%. One nephrectomy and seven pyeloplasties were performed and resolution of all patients' abdominal symptoms, including pain, resolved. Conclusions: Children with Dietl's crisis often suffer a delay in diagnosis; the clinical entity appears to be under-diagnosed. Renal parenchyma is typically preserved, and there is a paucity of associated urologic complaints. Once properly diagnosed, patients are well served by a pyeloplasty. Children with periumbilical pain and vomiting, particularly males, would benefit from ultrasound imaging.

Dietl’s crisis: an under appreciated clinical entity in the paediatric population

“…3 The absence of associated urologic symptoms contributes to the late referral to a paediatric urologist. 4 Fluid loading or feeding in young children causes Dietl's crisis and children often become symptomatic during the forced diuresis phase of dynamic scintigraphy scan with a diuretic. Once the proper diagnosis is made, patients are well served by a pyeloplasty with the resolution of pain symptoms.…”

Pediatric congenital hydronephrosis (ureteropelvic junction obstruction): Medical management guide

“…The disappearance of pain frequently reflects improvement in the HN. 17 If there are no urinary findings or if the symptoms are ambiguous, or there is only periumbilical pain, the pathology might be considered to be digestive tract disease and treated accordingly, which results in the delayed diagnosis of UPJO. The affected renal function is often preserved, because the obstruction is transient.…”

“…The rapid expansion of the renal collecting system, called intermittent HN, by excessive intake of fluids causes abdominal pain. The disappearance of pain frequently reflects improvement in the HN . If there are no urinary findings or if the symptoms are ambiguous, or there is only periumbilical pain, the pathology might be considered to be digestive tract disease and treated accordingly, which results in the delayed diagnosis of UPJO.…”

Akute Flankenschmerzen im Kindes- und Jugendalter

“…In der Literatur wird über Dietl´sche Krisen, von Josef Dietl 1864, als die Symptomtrias mit anfallsartigen Flankenschmerzen, Erbrechen und Oligurie als Manifestation einer Nephroptose beschrieben [33]. Auch bei symptomatischen Nierenbeckenabgangsengen im Kindesalter findet sich diese Trias [34,35]. Die meist betroffenen älteren Schulkinder werden mit rezidivierenden Flanken-und Bauchschmerzepisoden sowie Erbrechen klinisch symptomatisch.…”

“…Dass sich die Diagnose z.T. um Jahre verzögert, ist nicht verwunderlich, da eine Gastroenteritis oft klinisch näherliegend erscheint [34,35].…”