Presentation
Right sided flank pain and fevers
Patient Data
There is a large right perinephric collection. It contains a little high-density material. In delayed phase scans, contrast seen beading on the surface. It probably represents are large perinephric urinoma. Some hemorrhage associated. Right hydronephrosis is demonstrated with dilatation to the right ureter distally to bladder No obstructing calculus or mass present. The right ureter may have been ligated at the time of the Cesarean section. The left urinary tract is within normal limits.
Case Discussion
This 20-year-old presented to Emergency with two weeks of right-sided flank pain and subjective fevers at home for the last 24 hours. She had a history of an emergency Lower Uterine Segment Cesarean Section (LSCS) four weeks ago. She was tachycardic and febrile to 38.5. CT demonstrated a large right-sided peri-nephric collection thought to be a urinoma from a ruptured pelvicalyceal system. She also had associated right-sided hydronephrosis and hydroureter to the distal right ureter close to VUJ suggesting the right ureter may have been ligated at the time of LSCS.
She was managed with IV antibiotics, IV fluids and was transferred to a tertiary hospital for emergent percutaneous nephrostomy for source control.
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