Surgery MCQ Answer 64

Answer: a, b, c

Ninety percent of patients with retroperitoneal fibrosis present with dull, non-colicky pain in the back, flank, or abdomen. Other symptoms include weight loss, non-specific gastrointestinal complaints, and uncommonly, lower extremity edema, malaise, and dysuria. Laboratory studies may be normal in 25% of patients, but 55% of patients will have an elevated blood urea nitrogen. Diagnosis is most commonly suggested by intravenous pyelography. The combination of medial deviation of the ureter, hydroureteronephrosis, and extrinsic ureteral compression are highly suggestive of retroperitoneal fibrosis. CT scanning or MRI can both define the level of ureteral involvement and depict the mass appearance of the fibrotic process. Exploratory laparotomy with multiple deep biopsies of the retroperitoneal process is an essential part of diagnosis, since foci of carcinoma may be sparse within the predominately sclerotic reaction.

Treatment for retroperitoneal fibrosis must identify and deal with potential causative agents, relieve the ureteral obstruction, and reverse the inflammatory-fibrotic process. Renal obstruction may need to be relieved acutely, either by retrograde ureteral stents or by percutaneous nephrostomy tubes. Long-term resolution of ureteral obstruction most frequently has been accomplished by operative freeing of the ureters from the fibrosis and displacing them laterally or within the peritoneal cavity. Although renal function is improved in more than 90% of cases so treated, in as many as one-third of patients, ureteral obstruction recurs on the ipsilateral or contralateral side. Prognosis for patients with nonmalignant retroperitoneal fibrosis is good. Survivals of 86–100% for several years have been reported.

Category: Surgery MCQs