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Haidar A, Andour H, Essaber H, Abdallah H, El Bakkari A, Allioui S, Omor Y, Latib R. Imaging of an exceptional urinoma complicating a cervical cancer and leading to death: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241253748. [PMID: 38778909 PMCID: PMC11110504 DOI: 10.1177/2050313x241253748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Spontaneous urinoma is a rare urological complication that can occur following acute urinary obstruction. It involves a collection of urine that typically forms around the kidney as a result of rupture of the fornix. There are several causes of acute urinary stasis, including lithiasis, tumors, prostatic hypertrophy, and others. We present a unique case of an asymptomatic spontaneous urinoma discovered incidentally during the extension study of a 66-year-old woman with cervical cancer. The positive diagnosis was made through a combination of ultrasound and uro-computed tomography scan. The evolution was marked by the occurrence of a uremic encephalopathy, leading to death before any treatment.
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Affiliation(s)
- Ali Haidar
- Radiology Department, National Institute of Oncology, Rabat, Morocco
| | - Hajar Andour
- Radiology Department, National Institute of Oncology, Rabat, Morocco
| | - Hatim Essaber
- Radiology Department, National Institute of Oncology, Rabat, Morocco
| | | | - Asaad El Bakkari
- Radiology Department, National Institute of Oncology, Rabat, Morocco
| | - Soukaina Allioui
- Radiology Department, National Institute of Oncology, Rabat, Morocco
| | - Youssef Omor
- Radiology Department, National Institute of Oncology, Rabat, Morocco
| | - Rachida Latib
- Radiology Department, National Institute of Oncology, Rabat, Morocco
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2
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Sharma G, Sachdeva R, Aggarwal S, Verma A, Anand A, Singh A, Satapathy P. Isolated perinephric abscess as the initial manifestation of filariasis-an unusual presentation. Clin Case Rep 2024; 12:e8608. [PMID: 38444920 PMCID: PMC10912095 DOI: 10.1002/ccr3.8608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/06/2024] [Accepted: 02/16/2024] [Indexed: 03/07/2024] Open
Abstract
Key Clinical Message Filariasis may present as an isolated perinephric abscess. Hence, a high index of suspicion should be maintained in endemic settings. Abstract In cases with unexplained fever, eosinophilia and perinephric collection, it is necessary to do detailed infectious disease work up. High index of suspicion is required to diagnose filariasis due to its wide range of clinical presentation and laboratory findings. It may present as perinephric abscess, which can be diagnosed through ultrasonography.
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Affiliation(s)
- Govind Sharma
- Department of RadiodiagnosisRama Medical College Hospital and Research CentreHapurIndia
| | - Rajat Sachdeva
- Department of RadiodiagnosisRama Medical College Hospital and Research CentreHapurIndia
| | - Shweta Aggarwal
- Department of RadiodiagnosisRama Medical College Hospital and Research CentreHapurIndia
| | - Amogh Verma
- Rama Medical College Hospital and Research CentreHapurIndia
| | - Ayush Anand
- BP Koirala Institute of Health SciencesDharanNepal
| | - Ajeet Singh
- Dow University of Health SciencesKarachiPakistan
| | - Prakasini Satapathy
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical SciencesSaveetha UniversityChennaiIndia
- Medical Laboratories Techniques DepartmentAL‐Mustaqbal UniversityHillahBabilIraq
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3
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Moradkhani A, Zangi M, Azami M, Ghasemi-Rad M, Pakniyat A. The role of point-of-care ultrasound in the assessment of pelvic urine leakage and diagnosis of urinoma. Int J Emerg Med 2023; 16:91. [PMID: 38110890 PMCID: PMC10726508 DOI: 10.1186/s12245-023-00571-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/11/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Urinoma, a rare condition resulting from urine leakage due to trauma to the kidney, bladder, or urethra, is typically diagnosed using enhanced computed tomography urogram with delayed imaging. This report presents two cases of urinoma likely caused by overdistention of the renal pelvis following excessive fluid intake and the presence of a ureteral stone. CASE PRESENTATION We present two cases of 36-year-old and 38-year-old patients who presented with flank pain. point-of-care ultrasound (POCUS) played a pivotal role in identifying perinephric fluid in Morrison's space and the splenorenal space, respectively. These ultrasound findings guided further investigations, leading to definitive diagnoses via abdominal pelvic CT scans. Treatment involved prophylactic antibiotics and the successful placement of a double J stent into the renal pelvis over the wire under fluoroscopic guidance, which resulted in significant clinical improvement for both patients. CONCLUSIONS This study demonstrates the rare occurrence of urinoma from urolithiasis, the use of POCUS in expediting diagnosis and treatment, and the importance of interpreting sonographic images in the correct clinical setting.
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Affiliation(s)
- Asra Moradkhani
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mona Zangi
- Disaster and Emergency Management Center of Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mobin Azami
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mohammad Ghasemi-Rad
- Department of Interventional Radiology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, USA
| | - Abdolghader Pakniyat
- Department of Emergency Medicine, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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4
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de'Angelis N, Schena CA, Marchegiani F, Reitano E, De Simone B, Wong GYM, Martínez-Pérez A, Abu-Zidan FM, Agnoletti V, Aisoni F, Ammendola M, Ansaloni L, Bala M, Biffl W, Ceccarelli G, Ceresoli M, Chiara O, Chiarugi M, Cimbanassi S, Coccolini F, Coimbra R, Di Saverio S, Diana M, Dioguardi Burgio M, Fraga G, Gavriilidis P, Gurrado A, Inchingolo R, Ingels A, Ivatury R, Kashuk JL, Khan J, Kirkpatrick AW, Kim FJ, Kluger Y, Lakkis Z, Leppäniemi A, Maier RV, Memeo R, Moore EE, Ordoñez CA, Peitzman AB, Pellino G, Picetti E, Pikoulis M, Pisano M, Podda M, Romeo O, Rosa F, Tan E, Ten Broek RP, Testini M, Tian Wei Cheng BA, Weber D, Sacco E, Sartelli M, Tonsi A, Dal Moro F, Catena F. 2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery. World J Emerg Surg 2023; 18:45. [PMID: 37689688 PMCID: PMC10492308 DOI: 10.1186/s13017-023-00513-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/21/2023] [Indexed: 09/11/2023] Open
Abstract
Iatrogenic urinary tract injury (IUTI) is a severe complication of emergency digestive surgery. It can lead to increased postoperative morbidity and mortality and have a long-term impact on the quality of life. The reported incidence of IUTIs varies greatly among the studies, ranging from 0.3 to 1.5%. Given the high volume of emergency digestive surgery performed worldwide, there is a need for well-defined and effective strategies to prevent and manage IUTIs. Currently, there is a lack of consensus regarding the prevention, detection, and management of IUTIs in the emergency setting. The present guidelines, promoted by the World Society of Emergency Surgery (WSES), were developed following a systematic review of the literature and an international expert panel discussion. The primary aim of these WSES guidelines is to provide evidence-based recommendations to support clinicians and surgeons in the prevention, detection, and management of IUTIs during emergency digestive surgery. The following key aspects were considered: (1) effectiveness of preventive interventions for IUTIs during emergency digestive surgery; (2) intra-operative detection of IUTIs and appropriate management strategies; (3) postoperative detection of IUTIs and appropriate management strategies and timing; and (4) effectiveness of antibiotic therapy (including type and duration) in case of IUTIs.
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Affiliation(s)
- Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, Clichy, Paris, France
- Faculty of Medicine, University of Paris Cité, Paris, France
| | - Carlo Alberto Schena
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, Clichy, Paris, France.
| | - Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, Clichy, Paris, France
| | - Elisa Reitano
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Research Institute Against Digestive Cancer (IRCAD), 67000, Strasbourg, France
| | - Belinda De Simone
- Department of Minimally Invasive Surgery, Guastalla Hospital, AUSL-IRCCS Reggio, Emilia, Italy
| | - Geoffrey Yuet Mun Wong
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, 2065, Australia
| | - Aleix Martínez-Pérez
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - Vanni Agnoletti
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Filippo Aisoni
- Department of Morphology, Surgery and Experimental Medicine, Università Degli Studi Di Ferrara, Ferrara, Italy
| | - Michele Ammendola
- Science of Health Department, Digestive Surgery Unit, University "Magna Graecia" Medical School, Catanzaro, Italy
| | - Luca Ansaloni
- Department of General Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Miklosh Bala
- Acute Care Surgery and Trauma Unit, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem Kiriat Hadassah, Jerusalem, Israel
| | - Walter Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Graziano Ceccarelli
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Italy
| | - Marco Ceresoli
- General and Emergency Surgery, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Massimo Chiarugi
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, Riverside, CA, USA
| | - Salomone Di Saverio
- Unit of General Surgery, San Benedetto del Tronto Hospital, av5 Asur Marche, San Benedetto del Tronto, Italy
| | - Michele Diana
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Research Institute Against Digestive Cancer (IRCAD), 67000, Strasbourg, France
| | | | - Gustavo Fraga
- Department of Trauma and Acute Care Surgery, University of Campinas, Campinas, Brazil
| | - Paschalis Gavriilidis
- Department of HBP Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Angela Gurrado
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery "V. Bonomo", University of Bari "A. Moro", Bari, Italy
| | - Riccardo Inchingolo
- Unit of Interventional Radiology, F. Miulli Hospital, 70021, Acquaviva Delle Fonti, Italy
| | - Alexandre Ingels
- Department of Urology, Henri Mondor Hospital, University of Paris Est Créteil (UPEC), 94000, Créteil, France
| | - Rao Ivatury
- Professor Emeritus, Virginia Commonwealth University, Richmond, VA, USA
| | - Jeffry L Kashuk
- Department of Surgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jim Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, University of Portsmouth, Southwick Hill Road, Cosham, Portsmouth, UK
| | - Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, EG23T2N 2T9, Canada
| | - Fernando J Kim
- Division of Urology, Denver Health Medical Center, Denver, CO, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Zaher Lakkis
- Department of Digestive Surgical Oncology - Liver Transplantation Unit, University Hospital of Besançon, Besançon, France
| | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ronald V Maier
- Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Riccardo Memeo
- Unit of Hepato-Pancreato-Biliary Surgery, General Regional Hospital "F. Miulli", Acquaviva Delle Fonti, Bari, Italy
| | - Ernest E Moore
- Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
| | - Carlos A Ordoñez
- Division of Trauma and Acute Care Surgery, Fundación Valle del Lili, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Andrew B Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, USA
| | - Gianluca Pellino
- Colorectal Surgery Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Manos Pikoulis
- 3rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Michele Pisano
- 1st General Surgery Unit, Department of Emergency, ASST Papa Giovanni Hospital Bergamo, Bergamo, Italy
| | - Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
| | | | - Fausto Rosa
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery "V. Bonomo", University of Bari "A. Moro", Bari, Italy
| | | | - Dieter Weber
- Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Emilio Sacco
- Department of Urology, Università Cattolica del Sacro Cuore Di Roma, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Alfredo Tonsi
- Digestive Diseases Department, Royal Sussex County Hospital, University Hospitals Sussex, Brighton, UK
| | - Fabrizio Dal Moro
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy.
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5
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Mahawar R, Dharamshi JD, Shinde RK, Rathi C. Urinoma Due to Spontaneous Rupture of the Renal Pelvis Mimicking Appendicitis. Cureus 2023; 15:e36141. [PMID: 37065314 PMCID: PMC10101196 DOI: 10.7759/cureus.36141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/14/2023] [Indexed: 03/15/2023] Open
Abstract
Spontaneous rupture of the renal pelvis (SRRP) with urine extravasation is rare. This condition is primarily associated with an obstructing ureteric calculus. It creates a diagnostic dilemma, especially when the clinical diagnosis can be inconsistent. Herein, we report a 49-year-old male patient who presented with abdominal pain for the past three days and was diagnosed with acute appendicitis. A computed tomography (CT) scan revealed a right renal pelvis rupture and urinoma secondary to an obstructive 4 mm ureterovesical junction calculi. The patient was successfully treated with double-J stent placement. In conclusion, even though SRRP is rare, emergency physicians should have knowledge regarding this condition, which often presents as an abdominal condition and may be misdiagnosed as another condition requiring surgical intervention. Radiologic investigations such as CT scans are useful methods in suspected cases of this condition in order to reduce unnecessary surgical intervention.
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6
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Nontraumatic Paraureteral Urinoma in a Cat with Urolithiasis. Animals (Basel) 2022; 12:ani12212934. [DOI: 10.3390/ani12212934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/04/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
Urinoma is an encapsulated collection of urine due to a disruption in the collection system of the urinary tract. This condition is rarely reported in veterinary medicine. The aim of this study is to describe the clinical and diagnostic findings of a well-encapsulated paraureteral urinoma associated with urinary tract stones in a critical feline patient. The ultrasound examination of the abdomen revealed a well-defined collection of anechoic fluid containing the left kidney in the retroperitoneal space, while the radiographic examination revealed a loss of soft tissue contrast in the lumbar region. Both techniques confirmed the presence of stones in the bladder. Following the ultrasound-guided drainage of the lesion, the nature of the fluid was also confirmed to be urine. Due to the worsening of the cat’s health, to better define the extent and genesis of the lesion, a positive contrast radiographic study was performed by means of an ultrasound-guided percutaneous injection of a contrast medium into the lesion, which highlighted a wide and homogeneous radiopaque area in the left retroperitoneal space. These findings were confirmed with a postmortem examination, corroborating the diagnostic suspicion of urinoma. The percutaneous contrast inoculation performed in this critically ill patient plays a role in the diagnostic process to reach a final diagnosis in cases in which the patient’s clinical condition does not allow for performing an excretory positive contrast study.
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7
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Singh TP, Sharma A, Jaiswal H, Sethi RS. Development of a Peri-renal Urinoma in a Follow-up Patient with History Posttraumatic Peri-nephric Hematoma: Role of Renal Scintigraphy. Indian J Nucl Med 2021; 36:348-350. [PMID: 34658566 PMCID: PMC8481848 DOI: 10.4103/ijnm.ijnm_11_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/24/2021] [Indexed: 11/04/2022] Open
Abstract
A 7-year-old male with a history of blunt trauma to the abdomen and diagnosis of perinephric hematoma in contrast-enhanced computed tomography (CT) presented with increasing peri-nephric collection (after ~1.5 months) in the serial ultrasound examinations. The patient was referred to the department of nuclear medicine for the assessment of this collection as well as renal function. In 99mTc-diethylenetriamine pentaacetate renal scintigraphy, progressively increasing radiotracer activity was noted inferolaterally to the left kidney, separated from the same by a photopenic area. Single-photon emission computed tomography/CT revealed a peri-nephric urinoma in relation to the previously diagnosed hematoma at the lower pole; which was communicating with the pelvi-calyceal system (PCS). Not only did the renal scintigraphy aid in the diagnosis of urinoma but it was also able to show that it was communicating freely with the PCS and that the rest of the renal parenchyma was functioning adequately. This multi-faceted assessment in a single investigation allowed clinicians to opt for the conservative management despite the increasing size of urinoma in the early follow-up.
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Affiliation(s)
- Tejesh Pratap Singh
- Department of Nuclear Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Anshul Sharma
- Department of Nuclear Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Himanshu Jaiswal
- Department of Nuclear Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - R S Sethi
- Department of Nuclear Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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8
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Elmoheen A, Ponappan BR, John S, Thayyil N, Bashir K. Appendicitis Mimicking Urinoma: A Challenging Emergency Presentation Secondary to Ureteric Stone. Cureus 2021; 13:e14027. [PMID: 33898116 PMCID: PMC8058494 DOI: 10.7759/cureus.14027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
This article describes the case of a 38-year-old male who presented to the ED with three days history of gradually progressing right-sided lower abdominal pain, which had increased in severity two hours prior to his ED visit. The patient was anorexic but denied experiencing any fever, urinary malfunctions, or chills. Blood tests showed an elevated serum creatinine level of 123 umol/L and a high C-reactive protein level of 62 mg/L. Bedside point-of-care ultrasound (POCUS) imaging showed right-sided mild hydroureteronephrosis with surrounding perinephric fluid. Initially, based on the patient’s presentation and clinical findings, appendicitis or ureteric colic was strongly suspected. CT of the abdomen with contrast revealed urinoma measuring 16 cm, and there was a 3.2 mm calculus in the distal part of the right ureter, with perinephric and periureteric fat stranding. This rare phenomenon requires prompt care. Delayed medical treatment may result in complications like hydronephrosis, abscess, distorted electrolyte levels, and gradual loss of renal function. Small urinomas are usually treated conservatively, while large-sized urinomas often require aggressive medical treatment. A drainage catheter under CT or ultrasound guidance may be done, and additional decompression and drainage may be needed with percutaneous nephrostomy tubes. The fluid and urine culture guide antibiotic treatment.
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Affiliation(s)
- Amr Elmoheen
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT.,Emergency Medicine, College of Medicine, Qatar University, Doha, QAT
| | | | - Stanley John
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | | | - Khalid Bashir
- Medicine, Qatar University, Doha, QAT.,Emergency Medicine, Hamad Medical Corporation, Doha, QAT
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9
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Subcapsular urinoma following metastasis of testicular embryonal carcinoma. Urol Case Rep 2021; 37:101615. [PMID: 33680854 PMCID: PMC7930576 DOI: 10.1016/j.eucr.2021.101615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/16/2021] [Accepted: 02/20/2021] [Indexed: 11/24/2022] Open
Abstract
Urinoma is an uncommon and severe complication that commonly results from ureteral stone formation, causing urinary tract obstruction, urinary tract trauma, or a pelvis mass. Ureter perforation due to malignancy, leading to subcapsular urinoma, is rare. In this article, we aimed to describe a case of secondary subcapsular urinoma in an adult male. The patient was diagnosed with ureter perforation secondary to the invasion of embryonal carcinoma lymph node metastasis.
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10
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Artiles Medina A, Laso García I, Duque Ruiz G, Hevia Palacios M, Arias Funez F, Burgos Revilla FJ. Spontaneous urinoma debuting as retroperitoneal abscess: report of 2 cases and literature review. Transl Androl Urol 2021; 10:963-968. [PMID: 33718096 PMCID: PMC7947471 DOI: 10.21037/tau-20-1170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Spontaneous urinoma is a urological entity that can be complicated by a retroperitoneal abscess. Urinoma can be iatrogenic, traumatic, or can be caused by obstructive uropathy. We report two cases of spontaneous urinomas, describing a not previously published cause of urinoma: pyeloureteritis. (I) A 55-year-old Caucasian female started with intense left-sided flank pain for 3 days. CT scan revealed a voluminous retroperitoneal abscess, which extended through the posterior pararenal space and the left lumbar paravertebral musculature. (II) A 48-year-old Caucasian male presented with constitutional symptoms over the previous 2 months and investigations showed a voluminous urinoma and marked pyeloureteritis findings on CT scan. Both patients were managed by endoscopic placement of a double-J stent and drainage of the collection (open and percutaneous approach, respectively). Urinoma was confirmed by fluid biochemical analysis, which demonstrated that fluid creatinine was markedly raised as compared to the serum creatinine. Urinoma in the absence of obstruction or trauma is rare. These two case reports highlight one of the conditions leading to urinoma and the management of retroperitoneal abscess. Pyeloureteritis is a cause of spontaneous urinoma and it should be considered in the lack of another obstructive cause.
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Affiliation(s)
- Alberto Artiles Medina
- Department of Urology, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Inés Laso García
- Department of Urology, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Gemma Duque Ruiz
- Department of Urology, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Manuel Hevia Palacios
- Department of Urology, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Fernando Arias Funez
- Department of Urology, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Francisco Javier Burgos Revilla
- Department of Urology, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
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11
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Li Z, Beh JCY. Spontaneous bilateral renal pelvis rupture during CT in the absence of urinary tract obstruction: case report. BMC Urol 2020; 20:98. [PMID: 32660460 PMCID: PMC7359582 DOI: 10.1186/s12894-020-00669-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atraumatic renal pelvis rupture without pre-existing renal or ureteric pathology is an uncommon event. It is reported in the setting of acute urinary tract obstruction, most often secondary to ureteric calculi. Typical symptoms include acute flank pain and nausea, mimicking pyelonephritis or other causes of acute abdomen. Spontaneous rupture occurring bilaterally without identifiable urinary tract obstruction is exceedingly rare, and has yet to be reported in current English literature. Possible contributing pathophysiological mechanisms can be postulated from reported cases of rupture with observed obstruction. CASE PRESENTATION A 58-year-old woman undergoing multiphasic computed tomography (CT) for evaluation of asymptomatic microscopic haematuria developed on-table bilateral renal pelvis rupture seen only after contrast administration, on the delayed phase. There was no significant past medical history of note. The patient remained asymptomatic throughout and after the study, and was managed conservatively. Follow-up radiographical imaging over a month showed resolution of urinoma and no further contrast extravasation. No complications or recurrence was subsequently noted. CONCLUSIONS Spontaneous rupture of the renal pelvis can be a rare complication of intravenous contrast administration even in cases without identifiable urinary tract obstruction, and it can occur bilaterally. Cases can uncommonly be asymptomatic but typical symptoms should prompt evaluation of the kidneys, particularly when they are not included in the initial study or no delayed phase is protocolled. Interval imaging for resolution of urinoma and contrast extravasation is clinically relevant to monitor for and avoid infective sequelae.
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Affiliation(s)
- Zongchen Li
- National University Hospital, Singapore, Singapore.
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Soundararajan DCR, Maheswaran A, Kumarasamy D, Shetty AP, Kanna RM, Rajasekaran S. Delayed presentation of urinoma mimicking spondylodiscitis secondary to ureteric injury following carrot stick fracture in ankylosing spondylitis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:171-175. [DOI: 10.1007/s00586-020-06408-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 01/07/2023]
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Chen Y, Yan YF, Zhang Y, Carroll X, Li HR, Tao L, Sun MG, Leeper-Woodford S. Perinephric urinoma following spontaneous renal rupture in the third trimester of pregnancy: a case report and brief review of the literature. BMC Pregnancy Childbirth 2019; 19:505. [PMID: 31852454 PMCID: PMC6921490 DOI: 10.1186/s12884-019-2669-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 12/10/2019] [Indexed: 12/27/2022] Open
Abstract
Background Spontaneous formation of urinoma is a rare condition, especially for pregnant women. We report a patient in the third trimester of pregnancy with a spontaneous renal rupture who then develops a urinoma from urine leaking into the perinephric space. Case presentation A 23-year-old primagravida was diagnosed with a spontaneous renal rupture and acute left loin pain accompanied by hematuria when she was 35 weeks pregnant. A sub-capsular perinephric cyst then developed to a size of 319 × 175 × 253 mm, and because of discomfort to the patient, we performed Cesarean section. After a healthy male newborn was delivered, fluid was suctioned from a large perirenal cyst that had an estimated size of 300 × 200 × 300 mm. A percutaneous nephrostomy tube was left in the cyst until CT showed no remaining fluid. In the six-month follow-up, the patient showed no perirenal extravasation according to an ultrasound scan, and the urine analysis and renal function tests were normal. Conclusion Close follow-up should be recommended for the patient who has renal rupture after conservative therapy, especially for pregnant woman. CT or MRI should be considered in addition to utilizing ultrasound in the management of pregnant women who present with urinomas. Percutaneous nephrostomy is suggested as an appropriate treatment for large urinomas.
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Affiliation(s)
- Ya Chen
- Department of Obstetrics and Gynecologys, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Hefei, Anhui Province, China.,Anhui Medical University, Hefei, Anhui Province, China
| | - Yun Fang Yan
- Department of Obstetrics and Gynecologys, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Hefei, Anhui Province, China.,Anhui Medical University, Hefei, Anhui Province, China
| | - Ying Zhang
- Department of Obstetrics and Gynecologys, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China. .,Anhui Province Key Laboratory of Reproductive Health and Genetics, Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Hefei, Anhui Province, China. .,Anhui Medical University, Hefei, Anhui Province, China.
| | - Xianming Carroll
- Department of Public Health, Mercer University College of Health Professions, Atlanta, Georgia, USA
| | - Hui Rong Li
- Department of Obstetrics and Gynecologys, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Hefei, Anhui Province, China.,Anhui Medical University, Hefei, Anhui Province, China
| | - Li Tao
- Department of Obstetrics and Gynecologys, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Hefei, Anhui Province, China.,Anhui Medical University, Hefei, Anhui Province, China
| | - Mei Guo Sun
- Department of Obstetrics and Gynecologys, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Hefei, Anhui Province, China.,Anhui Medical University, Hefei, Anhui Province, China
| | - Sandra Leeper-Woodford
- Department of Biomedical Sciences, Mercer University School of Medicine, Macon, Georgia, USA
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