Department of Internal Medicine, Benefis Health System, Great Falls, MT, USA.
Am J Case Rep. 2021 Apr 27;22:e931404. doi: 10.12659/AJCR.931404.
BACKGROUND Perinephric hematomas are rare, especially following ureteral stent placement. Etiologies of perinephric hematomas include post-extracorporeal shockwave lithotripsy, Wunderlich syndrome, and renal cell carcinoma, none of which occurred in our patient, who underwent stent replacement. Subcapsular renal hematoma, rather than a perinephric hematoma, can occur following double-J ureteral stent placement. Also, renal parenchymal perforation leading to perinephric hematoma development are complications of double-J ureteral stent placement. Herein, we present a case of a perinephric hematoma following a double-J ureteral stent placement for a ureteral obstruction causing hydronephrosis. CASE REPORT A 43-year-old woman with type 2 diabetes mellitus, hypertension, systemic lupus erythematosus, and recurrent nephrolithiasis presented to our hospital with left flank pain of a 1-day duration. The patient was found to have an obstructive kidney stone causing hydronephrosis. She underwent stent placement and then developed a perinephric hematoma days later. Typically, hematomas are treated conservatively and have spontaneous resolution. The patient received 2 weeks of intravenous antibiotics and 2 more weeks of oral antibiotics, and failed conservative treatment. She re-presented to our hospital 3 days after discharge. Upon the second admission, a perinephric drain was placed. The patient was given another course of antibiotics and was discharged 18 days later. CONCLUSIONS A perinephric hematoma is a rare complication after ureteral stent placement. Perinephric hematoma development can be decreased by controlling blood pressure, treating preoperative urinary tract infections, and shortening operating time during ureteroscopy. It is important to reevaluate potential causes of continued abdominal pain with laboratory testing and repeat imaging.
肾周血肿较为罕见，尤其是在放置输尿管支架后。肾周血肿的病因包括体外冲击波碎石术后、Wunderlich 综合征和肾细胞癌，但这些均未发生在我们的患者身上，而该患者在进行支架更换后出现了肾周血肿。双 J 输尿管支架置入后可发生包膜下肾血肿，而非肾周血肿。此外，双 J 输尿管支架置入后导致肾实质穿孔而引起肾周血肿也是其并发症。在此，我们报告一例因输尿管梗阻导致肾积水而行双 J 输尿管支架置入后出现肾周血肿的病例。
一名 43 岁女性，患有 2 型糖尿病、高血压、系统性红斑狼疮和复发性肾结石，因左腰部疼痛 1 天就诊于我院。该患者发现有阻塞性肾结石导致肾积水。她接受了支架置入术，数天后出现了肾周血肿。通常，血肿采用保守治疗，可自行吸收。该患者接受了 2 周的静脉抗生素治疗和 2 周的口服抗生素治疗，但保守治疗失败。她在出院后 3 天再次就诊于我院。第二次入院时，放置了肾周引流管。患者接受了另一疗程的抗生素治疗，并于 18 天后出院。
肾周血肿是输尿管支架置入后的罕见并发症。通过控制血压、治疗术前尿路感染和缩短输尿管镜手术操作时间，可以减少肾周血肿的发生。重要的是，要通过实验室检查和重复影像学检查重新评估持续性腹痛的潜在原因。
