Ballad of a ballotable mass: giant hydronephrosis

Aims and Objectives: An interesting case report of a large ballotable mass due to Giant Hydronephrosis. Introduction: Giant hydronephrosis has been defined as kidney that occupies a hemiabdomen, which meets or crosses the mid¬line and which extends at least 5 vertebrae in length. Giant hydronephrosis (GH) is a rare entity, with less than 600 cases reported in the literature. Materials and methods: A 26 year old lady presented with complaints of left loin fullness for 1 year with no obstructive bowel or bladder complaints. On examination, the patient had a large ballotable mass in the left loin. CT scan revealed a large left kidney with gross hydronephrosis and paper thinning of cortical parenchyma. DTPA showed renal function of 9.1%. Results: The patient underwent Left Open Nephrectomy. The patient tolerated the procedure well and was discharged in stable condition. Conclusion: Nephrectomy is the procedure of choice in very poorly functioning kidneys however if kidney is salvageable then based upon the anatomical configuration, Reconstructive procedure should be selected. Delayed diagnosis and management of GH, can result in long-term complications like hypertension, rupture of the kidney, renal failure and malignant change.