Large Hutch diverticulum causing urinary obstruction

Case contributed by Dr Vinay V Belaval

Presentation

Dysuria and chronic lower abdominal pain.

Patient Data

Age: 60 years
Gender: Male

CT images show large diverticulum arising from left infero-lateral wall of urinary bladder (neck- 14 mm) measuring 11 x 5.8 x 9.7 cm (AP x TR x CC). The diverticulum is located at the level of left vesico-ureteric junction with left distal ureter opening into the diverticulum. These features are consistent with large congenital Hutch diverticulum of urinary bladder.

The diverticulum shows irregular wall thickening and enhancement- representing diverticulitis. Small calculus is noted in dependent portion of diverticulum.

Moderate left hydroureteronephrosis is noted with dilated extrarenal pelvis. No ureteric calculus is seen. There is medial deviation, stretching and narrowing of left distal ureter by the large diverticulum resulting in hydroureteronephrosis.

Left kidney is small in size with moderate parenchymal thinning. 

Coronal urographic phase image shows large urinary bladder diverticulum at vesico-ureteric junction level - consistent with congenital Hutch diverticulum.

Left distal ureter is seen opening into the diverticulum.

Case Discussion

Hutch diverticuli are congenital urinary bladder diverticuli occuring at the level of vesico-ureteric junction. These can present with long standing urinary obstruction in adults. 

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Case information

rID: 78315
Published: 2nd Jun 2020
Last edited: 4th Jun 2020
System: Urogenital
Inclusion in quiz mode: Included
Institution: Belcity Scan and Diagnostic Centre

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