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 percent to 51 percent. 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.