彰化基督教醫院 外科部 泌尿科
Spontaneous Renal Rupture Resulted from Severe Hydronephrosis Associated with Ureteral Obstruction: A Case Report
Po-Hung Tseng, Sheng-Hsien, Huang
Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
Spontaneous renal rupture is rupture of the renal parenchyma, collecting system, or renal blood vessel, which often arises from iatrogenic or non-traumatic factors such as severe hydronephrosis, upper urinary tract obstruction, pathological kidney such as polycystic kidney disease. It is clinically less common.
This 71-year-old female had past history of cervical cancer status post radiation therapy about 20 years ago. She suffered from gross hematuria and left hydronephrosis for about 3 years and came to our outpatient department and underwent ureteral dilatation with double-J tube placement for left middle ureteral stricture. The patient was regularly followed up renal echo and changed double-J tube every 3 months. Computed tomography of kidney examination for evaluation of upper urinary tract revealed left chronic renal disease and soft tissue compression of left middle ureter with severe hydronephrosis. Due to irritable lower urinary tract symptoms, patient asked for removal of double-J tube several times, but left flank pain recurrent after removal of double-J tube and followed kidney ultrasonogram indicated severe left hydronephrosis. Computed tomography of kidney showed spontaneous renal rupture with urinoma in left perirenal space and severe hydronephrosis. The patient was treated with CT- guided drainage with 8Fr. pigtail tube insertion for urinoma and collect fluid culture at first, it accordance with urine culture which reported Corynebacterium striatum. Due to recurrent urinary tract infection and ruptured left kidney with obstruction of left middle ureter, suspect pelvic tumor external compression, left nephroureterectomy with bladder cuff excision was performed. After surgery and post-operative care, she was discharged and regularly followed up at outpatient department.
Review the process of diagnosis and treatment experience from this case, for hydronephrosis caused by upper urinary tract obstruction resulting from stenosis, external compression or stone factors, even if chronic hydronephrosis or not, surgeons should be cautious of change of normal morphological structure of the kidney, attenuation of renal parenchyma, the possibility of renal rupture due to the increase of inner renal pressure and iatrogenic trauma of kidney mucosa with hard tip of hydrophilic guidewire during operation.