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Page 4 of 5 Goh et al. Mini-invasive Surg 2019;3:17 I http://dx.doi.org/10.20517/2574-1225.2019.06

metastasis to the urinary bladder and its association with the histological subtype has not been reported in
view of its rare occurrence, and will not make for a meaningful analysis in view of its small numbers.

This is the first reported case of a ureteric stricture with hydronephrosis and acute kidney injury resulting
from a metachronous esophageal cancer to the bladder. An accurate diagnosis of the cause of hydronephrosis
is crucial in all cases as it can affect the management of patients. In this case, the metastatic disease had
infiltrated the bladder submucosa and initial cystoscopy and ureteroscopy did not show any obvious bladder
mucosal or ureteric lesion, and he was treated as for a benign ureteric stricture. The initial CT scan did not
show any other abnormality such as local recurrence, metastatic spread to other organs or enlarged lymph
nodes to suggest metastatic disease. This case illustrates the importance of taking into consideration patient’s
past medical history and to consider the various differentials for hydronephrosis, regardless of how unlikely
or rare the possibility is. Ureteric re-implantation would be one of the treatment options for a long segment
tight ureteric stricture or if the stricture had recurred after balloon dilatation. A decision was made to follow
up with imaging first, which demonstrated the development of bladder wall thickening which eventually
led to the diagnosis of a metastatic esophageal cancer. Treatment will now be with palliative intent and a
percutaneous nephrostomy has been inserted to relieve the hydronephrosis, and the patient will be planned
for palliative chemotherapy. His baseline renal function was initially normal, but he subsequently developed
acute kidney injury due to obstructive uropathy. The percutaneous left nephrostomy relieved the obstruction
and his renal function returned to normal. A normal renal function is important as many chemotherapeutic
agents may cause nephrotoxicity and cannot be given in patients with renal impairment, or may need renal
dose adjustment. For this patient, he was treated with capecitabine (Xeloda).

DECLARATIONS
Authors’ contributions
Literature review: Goh D
Creation of manuscript: Goh D, Teo XL, Lim SKT

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Informed consent to participate in the study was obtained from the patient.

Consent for publication
Written informed consent was obtained from the patient for publication.

Copyright
© The Author(s) 2019.

REFERENCES
1. Napier KJ, Scheerer M, Misra S. Esophageal cancer: a review of epidemiology, pathogenesis, staging workup and treatment modalities.
World J Gastrointest Oncol 2014;6:12-20.