Giant hydronephrosis is a rare manifestation of upper urinary tract obstruction. On clinical examination, a colonic band of resonance is appreciated on percussion due to presence of transverse colon anterior to the renal lump. However, visualizing the colon on inspection is not reported in the literature.
A 13-year-old girl presented with abdomen distension for a duration of two years. On clinical examination, the abdomen was grossly distended, with left side of abdomen more prominent. On inspection, the colonic impression was visualized. There was large cystic lump, above which, the colonic impression was observed. With percussion we could elicit the colonic band of resonance as well. Imaging and radionuclide scan revealed giant hydronephrosis of left kidney with poor function. Patient underwent a laparoscopic nephrectomy. Patient was discharged after 3 days.
Giant hydronephrosis can present as gross abdomen distension. The presence of colon anterior to the renal lump can be appreciated by inspection during the clinical examination.

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