Ureteric obstruction is amongst the commonest urological emergencies with the most frequent cause being renal stone disease. The emergency physician should, however, have a high index of suspicion to help in identifying other causes of ureteric obstruction.

A 64 year old male presented with acute-on-chronic renal failure, having previously had a left nephroureterectomy for renal cell carcinoma. Ultrasonography showed evidence of moderate hydronephrosis of the solitary right kidney. An emergency nephrostomy was performed and a nephrostogram showed a laterally displaced obstructed ureter. An unenhanced computed tomography scan revealed the obstructing lesion to be a large (8.7×8.5 cm) right external iliac artery aneurysm that was also demonstrated on angiography (fig 1). This was treated by endovascular stenting.

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Figure 1

 Angiography demonstrating a large external iliac artery aneurysm which was the cause of the ureteric obstruction.

External iliac artery aneurysms causing ureteric obstruction in a solitary kidney are rare with only four reported cases.¹ Early diagnosis requires a high index of suspicion and subsequent radiological imaging. Emergency treatment includes nephrostomy and urinary drainage.