Abstract

Introduction: Retroperitoneal fibrosis (RPF) is an uncommon condition in which a predominantly inflammatory plaque encasing the aorta, inferior vena cava, ureters, other retroperitoneal structures. A definitive etiology of RPF is found in only 30% of cases. In patients with secondary RPF 8-10 % has been reported to have malignant etiology.

Materials and Methods: Between 2003 and 2011 we have treated 14 cases of RPF at our institute who had presented with renal failure. Eleven patients underwent surgical exploration and specimen sent for histopathological examination. Only DJ stenting in 2 patients. One had PCN. One patient died with hyperkalemia preoperatively, one after completion of chemotherapy, Post operatively treated with steroids for 1 year.

Results: In all cases renal parameters optimized with bilateral (B/L) DJ stenting. Out of 12 cases, 7 patients underwent ureterolysis with intraperitonealization, B/L ureterolysis with boari flaps in two patients, ureterolysis with uretero ureterostomy in one patient, Unilateral  ureterolysis in one patient, only b/l dj stenting in 1 patient.. Histopathological examination showed Non hodgkin’s lymphoma (NHL) in three cases, Tuberculosis in three cases, Non specific inflammation (Idiopathic) in 6 cases. one patient on b/l dj stents got symptomatic relief with ATT. Peritoneal biopsy revealed tuberculosis

Observations: In our series of RPF malignancy contributes 25% of cases and tuberculosis was seen in 25%. Surgical exploration has better outcome in cases of RPF regardless of aetiology to exclude malignancy and to prevent end stage renal disease. Long-term follow-up of these cases is warranted.

Keywords: retroperitoneal fibrosis, ureterolysis, intraperitonealization.