Abstract
Background
Rupture of the urinary collecting system with or without any perinephric extravasation is an extremely rare occurrence and usually known to occur following an obstructive pathology. Spontaneous or non-traumatic rupture, in the absence of any distal obstruction, though reported in literature, is not yet a proven entity and needs to be distinguished from physiological forniceal rupture to validate its occurrence. Our case illustrates that spontaneous ureteric rupture does exist and requires a high level of vigilance for prompt diagnosis and early simple management.
Case Presentation
A 65-year-old non-diabetic gentleman presented with a 2-day history of right-sided severe abdominal pain with no history of any prior trauma, surgery, urinary retention, or calculus disease. His ultrasound whole-abdomen was suggestive of increased liver echogenicity, but his contrast-enhanced CT scan (CECT) documented a ureteric rupture, with leakage of contrast from the upper ureters, well away from the renal pelvis. He was promptly managed with cysto-ureteroscopy, retrograde pyelography (RGP), and double-J (DJ) stenting. His post-operative course was uneventful, and he was discharged on the second post-operative day, without event. An RGP at 6 weeks of follow-up showed no contrast extravasation from the ureter, and his DJ stent was removed without event.
Conclusion
Spontaneous ureteric rupture, in the absence of any inciting cause, is an entity that exists and is easily manageable once diagnosed timely. Thus, the need to maintain a high index of vigilance, in order to identify this clinical entity at the earliest, institute prompt treatment, and hence ensure that a “spontaneous” rupture doesn’t become a “faux pas” in the true sense of the word.
Key Questions
1. What is spontaneous ureteric rupture?
Spontaneous ureteric rupture is a rare condition where the ureter ruptures without any apparent external cause, such as trauma or calculi, and occurs in the absence of distal obstruction.
2. How is spontaneous ureteric rupture diagnosed?
Diagnosis typically involves imaging techniques such as contrast-enhanced CT scans, which can reveal leakage of contrast from the upper ureter away from the renal pelvis.
3. What is the treatment for spontaneous ureteric rupture?
Spontaneous ureteric rupture is usually treated through cysto-ureteroscopy, retrograde pyelography (RGP), and double-J stenting to allow the ureter to heal.
4. What is the prognosis for patients with spontaneous ureteric rupture?
With prompt diagnosis and treatment, the prognosis for patients with spontaneous ureteric rupture is excellent, with most patients experiencing a full recovery following stent placement and monitoring.
