DIETLS CRISIS - A SYNDROME OF EPISODIC ABDOMINAL-PAIN OF UROLOGIC ORIGIN THAT MAY PRESENT TO A GASTROENTEROLOGIST

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