title: Bilateral ureteric obstruction during in vitro fertilisation therapy in a patient with complex surgically managed Crohn's disease.
abstract: A 37-year-old woman receiving in vitro fertilisation (IVF) treatment presented with lethargy, fevers and anuria. Her background included complex surgically managed Crohn's disease and mild right-sided hydronephrosis (with no evidence of obstruction on MAG3 renogram). On examination, she had a distended abdomen with generalised tenderness. Blood tests revealed an acute kidney injury and confirmed sepsis. She was found to have bilateral ureteric obstruction with worsening of the right-sided hydronephrosis and new-onset left-sided hydronephrosis secondary to bilateral ovarian masses, diagnosed as mild ovarian hyperstimulation syndrome (OHSS). She was initially managed with fluid resuscitation, bilateral nephrostomies, antibiotics and supportive management of mild OHSS. She made a good recovery and was discharged after placement of antegrade stents and removal of nephrostomies. On follow-up, following resolution of ovarian hyperstimulation, she has been diagnosed with a right-sided distal ureteric stricture and is awaiting reconstruction. Her left ureteric stent has been removed.
authors.affiliation: Department of Urology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK.
authors.forename: Christopher Charles
authors.initials: CC
authors.lastname: Khoo
authors.affiliation: Department of Urology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Ahluwalia
authors.affiliation: Assisted Conception Unit, Guy's and Saint Thomas' NHS Foundation Trust, London, UK.
authors.forename: Jan
authors.initials: J
authors.lastname: Grace
authors.affiliation: Department of Urology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK.
authors.forename: Arun
authors.initials: A
authors.lastname: Sahai
mesh_terms: D000328:Adult; D001002:Anuria / Q000209:etiology; D003424:Crohn Disease / Q000150:complications* / Q000601:surgery; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects*; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology; D016471:Ovarian Hyperstimulation Syndrome / Q000175:diagnosis; D014517:Ureteral Obstruction / Q000209:etiology*