Presentation
Acute onset of right iliac fossa pain, progressive. Normal inflammatory markers. Negative prior trauma.
Patient Data
Right perirenal fat stranding and an ill-defined anterior and parapelvic low-density fluid collection exist. There is no nephroureterolithiasis and no renal tract obstruction bilaterally.
The renal excretory phase at approximately 15 minutes demonstrates an extrinsic impression on the renal pelvis and proximal non-dilated ureter however no extravasated contrast is present.
The patient had a prior biliary pancreatic diversion (BPD) and a duodenal switch (DS), with no bowel obstruction, no internal hernia and no free intraperitoneal air.
The appendix is absent.
Image courtesy: Dr Amaresh I Ranchod
Due to initial CT findings and radiological suspicion of a renal pelvis rupture, the patient was recalled for a delayed CT scan at approximately 90 minutes following the initial contrast bolus injection.
The delayed scan confirmed a spontaneous right renal pelvis rupture with extravasated contrast confirming the low-density fluid on the initial CT to represent a urinoma. The proximal right ureter is well demonstrated and remains intact.
Case Discussion
An example of a spontaneous rupture of the renal pelvis and peripelvic urinoma.
The patient has no prior history of nephroureterolithiasis and additionally does not present with signs and symptoms to suggest prior renal colic and a possible passed calculus. Additionally, no other cause of ureteric obstruction was identified in the CT series.
The inflammatory markers, white cell count, and urine analysis were normal, thus excluding urosepsis as a potential cause of the spontaneous rupture.
The cause of the spontaneous renal pelvic rupture remains uncertain.
Spontaneous rupture of the renal pelvis is due to increased intrapelvic pressure 1.
Causes include 1:
urinary tract obstruction ( ureteric calculi, benign and malignant tumors, pregnancy, posterior urethral valves, PUJ obstruction, extrinsic vascular compression and retroperitoneal fibrosis)
ureteric instrumentation
urosepsis
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