Ahmed Hatem, Mansour Mohamed K, Obeid Hamza
Internal Medicine, Phoenixville Hospital - Tower Health Medical Group, Phoenixville, USA.
Hospital Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, ARE.
Cureus. 2024 Dec 3;16(12):e75017. doi: 10.7759/cureus.75017. eCollection 2024 Dec.
Acute kidney injury (AKI) is typically classified as prerenal, renal, or postrenal in etiology, with postrenal often referring to obstructive causes. However, certain uncommon conditions, such as intraperitoneal urinary leaks, may not fit clearly into these categories. In patients with a recent history of pelvic procedure, a complication such as intraperitoneal urinary leak can mimic AKI due to urine reabsorption across the peritoneum. When these leaks present beyond the immediate postoperative period, they can be challenging to diagnose, potentially leading to delayed management and complications. We report the case of a male patient who presented with lower abdominal pain and dysuria four weeks after undergoing radical prostatectomy. His initial evaluation, including urinalysis and imaging, suggested a urinary tract infection (UTI), and he was discharged with antibiotics. Three days later, he returned to the emergency room with persistent symptoms, new-onset diarrhea, and elevated creatinine compared to baseline. He was diagnosed with AKI, presumed to be secondary to dehydration, and received intravenous (IV) fluids. Despite undergoing treatment, his symptoms worsened, with further deterioration in renal function in the absence of a clear cause. An abdominal MRI ultimately revealed a fluid collection behind the bladder, indicative of a urinoma. His symptoms and renal function improved significantly after the Foley catheter placement. Intraperitoneal urinary leaks should be considered in post-pelvic surgery patients with unexplained serum creatinine elevations, as delayed recognition can lead to significant morbidity. This report underscores the importance of including intraperitoneal urinary leaks in the differential diagnosis for patients presenting with AKI following recent pelvic surgeries or procedures.
急性肾损伤（AKI）在病因上通常分为肾前性、肾性或肾后性，肾后性通常指梗阻性病因。然而，某些罕见情况，如腹腔内尿液渗漏，可能并不明确符合这些类别。在近期有盆腔手术史的患者中，诸如腹腔内尿液渗漏这样的并发症可因尿液经腹膜重吸收而类似AKI。当这些渗漏在术后即刻之后出现时，诊断可能具有挑战性，可能导致治疗延迟及并发症。我们报告一例男性患者，在接受根治性前列腺切除术后四周出现下腹痛和排尿困难。其初始评估，包括尿液分析和影像学检查，提示泌尿系统感染（UTI），他接受抗生素治疗后出院。三天后，他因症状持续、新发腹泻且肌酐水平较基线升高而复诊至急诊室。他被诊断为AKI，推测继发于脱水，并接受了静脉补液。尽管接受了治疗，其症状仍恶化，在无明确病因的情况下肾功能进一步恶化。腹部MRI最终显示膀胱后方有液体积聚，提示尿瘤形成。放置Foley导尿管后，他的症状和肾功能显著改善。对于盆腔手术后血清肌酐不明原因升高的患者，应考虑腹腔内尿液渗漏，因为延迟识别可导致严重发病。本报告强调了在近期盆腔手术或操作后出现AKI的患者鉴别诊断中纳入腹腔内尿液渗漏的重要性。
