Forbes J Med. 2021; 2(1): 41-45 | DOI: 10.5222/forbes.2021.74936

Acute Abdominal Pain Due to Spontaneous Renal Calyceal Rupture: Clinical Presentation, Diagnosis and Management

Erem Kaan Baþok
Department of Urology, Izmir University of Economics, Faculty of Medicine, Izmir, Turkey.

Background: Rupture of renal calyces with urinoma, mimicking acute abdomen, is an unusual condition that is mostly caused by distal ureteral stone.
Case Presentation: Ultrasonographic evaluation showed right hydronephrosis in a woman who was admitted to our emergency department with persistent severe abdominal pain. A delayed contrast -enhanced computerized tomography (CT) was required to confirm the diagnosis of rupture in symptomatically worsening patient. Among various treatment options conservative treatment was preferred, the patient was recovered, and urinoma was resolved without any complication. Diagnosis and treatment options are discussed.
Conclusion: A spontaneous rupture of the urinary system can mimic acute abdomen, and should always be considered in the differential diagnosis of a patient presenting complex symptoms after renal colic. If a definite diagnosis cannot be established by routine imaging modalities, delayed phase contrast- enhanced CT would be helpful in this regard. Conservative treatment with careful monitoring is an option with good results, thus it may obviate the need for surgical intervention in most of the patients.

Keywords: rupture, stone, computed tomography, abdominal pain

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Spontan Renal Kaliks Rüptürüne Baðlý Akut Karýn Aðrýsý: Klinik Görünüm, Taný ve Tedavi

Erem Kaan Baþok
Ýzmir Ekonomi Üniveristesi Týp Fakültesi, Üroloji Ana Bilim Dalý, Ýzmir, Türkiye

Giriþ: Renal kaliks rüptürü ve beraberinde oluþan ürinom çoðunlukla distal üreter taþýndan kaynaklanan ve akut karný taklit eden alýþýlmadýk bir durumdur.
Olgu Sunumu: Acil servisimize inatçý ve þiddetli karýn aðrýsý ile baþvuran bir kadýn hastaya yapýlan ultrasonografik incelemede sað böbrekte hidronefroz saptandý. Semptomatik olarak kötüleþen hastada rüptür tanýsýný doðrulamak için gecikmiþ faz kontrastlý bilgisayarlý tomografi (BT) gerekliydi. Farklý tedavi seçenekleri arasýndan konservatif tedavi tercih edildi, sonrasýnda ürinom komplikasyonsuz düzeldi ve hasta iyileþti. Taný ve tedavi seçenekleri tartýþýldý.
Sonuç: Üriner sistemin spontan rüptürü akut karný taklit edebilir ve renal kolik sonrasý kompleks semptomlar gösteren bir hastanýn ayýrýcý tanýsýnda her zaman düþünülmelidir. Rutin görüntüleme modaliteleri ile kesin bir taný konulamazsa, gecikmiþ faz kontrastlý BT bu açýdan yardýmcý olacaktýr. Dikkatli izleme ile konservatif tedavi, iyi sonuçlara sahip bir seçenektir ve bu nedenle hastalarýn çoðunda cerrahi müdahale ihtiyacýný ortadan kaldýrabilir.

Anahtar Kelimeler: rüptür, taþ, bilgisayarlý tomografi, karýn aðrýsý

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