Spontaneous renal tract rupture from obstructing vesico‐ureteric junction calculus

• Published in: Clinical case reports Vol. 10; no. 5; pp. e05820 - n/a
• Main Authors: Okpii, Emmanuel C., Adamu‐Biu, Fatima, Okpii, Kingsley C.
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.05.2022; John Wiley and Sons Inc; Wiley
• Subjects: Abdomen; Aortic aneurysms; Aortic dissection; Back pain; Case Report; Case Reports; Catheters; Conflicts of interest; Excretory system; Hypertension; Lasers; Patients; renal calculus; spontaneous renal rupture; Tomography; Urine; Urogenital system; spontaneous renal rupture; renal calculus
• ISSN: 2050-0904; 2050-0904
• DOI: 10.1002/ccr3.5820

Spontaneous or non‐traumatic rupture of the renal tract is an infrequent presentation, and it is most frequently caused by ureteric obstruction. Rupture could occur at any level of the upper urinary tract. However, it is most common at the renal calyces and complications that could arise include; urinoma, and or hematoma collection which could progress to abscess formation and sepsis. We report a 77‐year‐old male patient who attended the emergency department following referral from his general practitioner with a 6‐day history of progressively worsening left sided abdominal pain. Due to his co‐morbidities, presenting blood pressure and age, he was suspected of having an aortic dissection or ruptured abdominal aortic aneurysm and subsequently had a CT (computed tomography) Angiogram. This showed extravasation of contrast from the left kidney with a 12 mm obstructing vesico‐ureteric junction calculus necessitating urgent urology referral and prompt review. He was worked up for a ureteric double J stent insertion, however, the procedure was unsuccessful due to complex multiple urethral strictures. The patient subsequently had a nephrostomy inserted and was planned for optical urethrotomy, rigid cystoscopy, rigid/flexible ureteroscopy, and laser stone fragmentation of left obstructing vesico‐ureteric junction calculus. Spontaneous renal tract rupture is a rare presentation and commonly results from ureteric obstruction. It should be considered in suspected renal colic and management will, however, depend on the cause and level at which rupture occurs.