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March 13, 1967

Abdominal Pain, Intermittent Hydronephrosis, and Accessory Renal Vessels

JAMA. 1967;199(11):846-848. doi:10.1001/jama.1967.03120110118027

THE DIFFERENTIAL diagnosis of the patient with vague upper abdominal pain apparently arising in the right upper quadrant includes the standard considerations such as cholecystitis, ulcer disease, and functional bowel distress. This last diagnosis was made in several of the patients whose cases are reported here and who later proved to have intermittent hydronephrosis caused by accessory renal vessels. Unless specific questions are put regarding the periodicity of the pain and its relationship to maintained positions of the body and/or the ingestion of large quantities of fluid, the correct diagnosis may not be suspected. When the diagnosis is considered and an excretory urogram is performed in the absence of the pain, the hydronephrosis may not be demonstrated.1,2 The necessity of performing the urogram during an attack of pain is emphasized herein. The data on nine young adults with this syndrome observed during the past ten years at the University