Ureter rupture by calculi

Case contributed by Dr Domenico Nicoletti

Presentation

Severe colicky left sided flank pain associated with two episodes of vomiting and chills.

Patient Data

Age: 45
Gender: Male
CT

Abdominal CT with contrast

A non-contrast Computed Tomography of the abdomen was performed which showed two 2–3 mm stones in the pelvic part of the left ureter, near the meatus with free fluid in the left retroperitoneum, suggestive of a perforation of the left collecting system. A delayed scan was performed to achieve a CT Intra-Venous Urogram. This confirmed extravasation of contrast medium around the left ureter, the rupture being at the lumbar level of the ureter. In both kidneys there are multiple stones.

CT

Coronal view reconstructions using maximum intensity projection, showing ureteric leak of contrast at the lumbar level.

Case Discussion

Spontaneous rupture of the ureter often occurs secondary to ureteral lithiasis with urinary tract obstruction and resultant increased intraluminal pressure and subsequent rupture or can be secondary to a tear of the ureter during passage of the stone. Peritoneal irritation by urine results in presentation with an acute abdomen. Abdominal CT with contrast and urographic phase, allows the correct diagnosis.

Case courtesy: Dr.ssa Alessandra Guerra

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Case information

rID: 70376
Published: 15th Aug 2019
Last edited: 15th Aug 2019
System: Urogenital
Inclusion in quiz mode: Included

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