Khalid Syed Yousaf, Waraich Tauqir Aslam, Muhammad Osman, Omer Shawgi
Cardiothoracic Surgery, St. James's Hospital, Dublin, IRL.
Department of Urology, Letterkenny University Hospital, Letterkenny, IRL.
Cureus. 2025 Jan 6;17(1):e76999. doi: 10.7759/cureus.76999. eCollection 2025 Jan.
Spontaneous rupture of the renal collecting system due to an obstructing ureteric stone is a rare, but significant complication. We present the case of a 27-year-old woman who presented with sudden, severe abdominal pain initially suspected to be of gynecological origin. Further investigation revealed a 3-mm obstructing stone at the vesicoureteric junction causing calyceal rupture. Rupture due to such small stones is rare and may be overlooked on non-contrast CT; however, the presence of perinephric edema or fluid should raise suspicion of this complication. The diagnosis was confirmed using contrast-enhanced CT, which demonstrated contrast extravasation. The patient was initially managed conservatively with analgesia, antibiotics, and alpha-blockers; however, persistent pain and the risk of worsening urinary extravasation necessitated cystoscopy and JJ stent placement. The postoperative recovery was favorable, and the patient was discharged on the second day. Follow-up ureteroscopy revealed no residual stones and the stent was successfully removed. This case highlights the importance of early diagnosis and timely urological intervention to prevent complications, such as urosepsis, urinoma, and acute kidney injury. While conservative management may suffice for small, passable stones, stenting is necessary in cases of obstructive uropathy, infection, or significant rupture. This report emphasizes the clinical presentation, diagnostic challenges, and management strategies of this rare but important condition. Prompt recognition and appropriate treatment are essential to achieve favorable outcomes.
因输尿管结石梗阻导致的肾集合系统自发性破裂是一种罕见但严重的并发症。我们报告一例27岁女性病例，该患者最初因突发剧烈腹痛就诊，最初怀疑为妇科原因。进一步检查发现膀胱输尿管连接处有一枚3毫米的梗阻性结石，导致肾盏破裂。如此小的结石导致的破裂很少见，在非增强CT上可能被忽视；然而，肾周水肿或积液的存在应引起对这种并发症的怀疑。通过增强CT确诊，显示有造影剂外渗。患者最初采用镇痛、抗生素和α受体阻滞剂进行保守治疗；然而，持续疼痛以及尿外渗恶化的风险使得必须进行膀胱镜检查并置入双J支架。术后恢复良好，患者于第二天出院。随访输尿管镜检查未发现残留结石，支架成功取出。该病例强调了早期诊断和及时进行泌尿外科干预以预防诸如尿脓毒症、尿瘤和急性肾损伤等并发症的重要性。虽然对于小的、可通过的结石保守治疗可能足够，但对于梗阻性尿路病、感染或严重破裂的病例，置入支架是必要的。本报告强调了这种罕见但重要疾病的临床表现、诊断挑战和管理策略。迅速识别和适当治疗对于取得良好结果至关重要。
