Highlights
- •Renal calyceal rupture occurs secondary to a relatively large obstructing ureteral calculus.
- •High index of suspicion for calyceal rupture should be present even in the scenario of a small urolithiasis.
- •Contrast enhanced CT scan is vital for the diagnosis.
- •Management by a double–J ureter stent insertion can yield good clinical outcome.
Abstract
Background
Spontaneous urinary collecting system rupture is caused by increased ureteral intraluminal
pressure secondary to an obstruction. Rarely, a small stone exerts high intraureteral
pressure especially if it is located distally. Many management modalities with good
outcomes have been implicated.
Purpose
Herein, we present a case of nontraumatic rupture of the renal calyx due to a 4 mm
obstructing stone at the vesicoureteral junction.
Basic procedures
CT scan of abdomen and pelvis without contrast, CT scan of the abdomen and pelvis
with intravenous contrast, Cystoscopy, Double–J ureter stent, Urinary Foley catheter.
Main findings
The diagnosis was confirmed by CT imaging. Non-contrast enhanced CT scan of abdomen
and pelvis showed obstructive calculi measuring 4 mm in the right vesicoureteral junction.
Contrast-enhanced CT scan revealed leakage of contrast in the perinephric space at
the right major calyx with intact bilateral ureters, suggestive of calyceal rupture.
The treatment involved antibiotics and double-J stenting.
Principal conclusions
This case demonstrates that spontaneous calyceal rupture should be suspected in urolothiasis
patients presenting for a severe pain even if the calculus is small (less than 5 mm)
and the laboratory markers are normal. An immediate management is required to relief
symptoms and prevent further complications.
Keywords
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Article info
Publication history
Published online: December 24, 2019
Accepted:
October 31,
2019
Received in revised form:
October 29,
2019
Received:
September 20,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
