Dietl Syndrome: Intermittent Ureteropelvic Junction Obstruction as a Cause of Episodic Abdominal Pain

Intermittent ureteropelvic junction obstruction, often associated with an aberrant vessel to the lower pole of the kidney, may cause a distinct clinical syndrome of episodic crampy upper abdominal pain, nausea, and vomiting known as a Dietl crisis. Although Josef Dietl1 first described this clinical entity in 1864, and numerous reports appear in the English language urologic and radiologic literature dating back to 1909,2 there has been only one recent report in the pediatric literature.3 In the latter report, renal ultrasonography was recommended as a screen for intermittent ureteropelvic junction obstruction in children with recurrent abdominal pain. We recently saw two patients in whom the diagnosis of intermittent ureteropelvic junction obstruction was not made by ultrasound.