Case Report: Spontaneous Intraperitoneal Rupture of an Infected Kidney in A Young Patient
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- Category: Vol. 83, September 2015
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Case Report: Spontaneous Intraperitoneal Rupture of an Infected Kidney in A Young Patient, ADEL A. ASSIRI
Abstract
Background: Non-traumatic or spontaneous rupture of the kidney is rare. There is usually an underlying pathology, e.g., hydronephrosis, calculi, pyonephrosis, or tumors.
Objective: To present an unusual presentation of a young man presenting with an acute abdomen and having a final diagnosis of ruptured renal pelvis.
Case Report: A 21 years old male presented with severe pain at the right iliac fossa for 2 days associated with loss of appetite, vomiting and fever. On physical examination, the patient looked sick, with tachycardia (120 beats/min), blood pressure 125/83mmHg, febrile (38ºC) with generalized ab-dominal tenderness and guarding. Urine dipstick revealed blood (++) but no protein, high leukocytic count, and C-reactive protein. Abdominal X-ray showed no abnormal findings. The provisional diagnosis was "perforated appendix", however, the abdominal CT scan revealed normal appendix and a distal right ureteric stone with significant perinephric pus collection extending to the pelvis. Third generation cephalosporin was started and he was taken to the operative theater. Endoscopically, a ureteral stent was fixed. Postoper-atively, the patient dramatically improved, and was discharged 3 days after surgery. Six weeks later, the ureteral stent was removed. Retrograde pyelogram was done and there was no extrvasation with complete healing of the renal pelvis. The stone was fragmented using Holmium: YAG laser.
Conclusions: Early diagnosis of underlying renal or ureteral stones in patients presenting with peritonitis is im-portant. Full urological investigations in such cases are important to avoid severe complications.