Spontaneous Peripelvic Extravasation of Urine as a Cause of Acute Abdomen

Abstract

In eight patients with sudden onset of flank pain, urography showed extravasation of urine. The cause of peripelvic leakage was verified ureteral stone in four cases, stricture of the ureteropelvic junction in one, and unknown in three cases. Treatment was symptomatic in four cases, drainage in two and surgery in two cases. Seven patients recovered uneventfully, but one required nephrectomy. The prognosis in spontaneous urinary extravasation is usually good without drainage. Open surgery is seldom indicated.

Bilateral ureteral complete obstruction with huge spontaneous urinoma formation in a patient with advanced bladder cancer

“…This is considered to be a protective physiological mechanism producing decompression that may protect the kidney from high-pressure injury. 6,7 The latter results from direct injury by a stone during its passage. 8,9 The mechanism underlying urinary extravasation in tumor disease may be different from that caused by a stone owing to the gradual increase in intrarenal pressure.…”

Never underestimate renal colic: a case of pelvic rupture

“…It is due, in most cases, to an ureteral obstruction by calculus; other causes are trauma, tumors, pregnancy, diagnostic and interventional procedures. [1][2][3][4] Diagnosis, as reported in literature, is often difficult and has to be differentiated with numerous causes of abdominal pain due to involvement of perirenal abdominal structures and organs. It is usually recognized with a contrast-enhanced computed tomography (CT) showing passage of contrast medium into peripelvic, perirenal and retroperitoneal spaces.…”

Spontaneous Fornix Rupture Due to Obstructive Ureteral Stone

“…Spontaneous rupture of the calix/fornix renalis causing urinary extravasation to perirenal or retroperitoneal area is not frequent among the complications of obstructive nephropathy. However, most fornix ruptures are associated with ureteral obstructions due to ureteral or ureteropelvic junction stones (3,4). Other causes of secondary ureteral obstruction include posterior urethral valve, prostate hyperplasia, pregnancy and advanced ovarian cancer.…”

“…However, there are some signs and symptoms suspicious for rupture of the fornix. These include change in typical characteristic of renal colic with transition to diffuse lumbar pain and peritoneal irritation findings, leukocytosis and increased body temperature in most cases, loss of psoas shadow and antalgic posture in the vertebrae to diseased kidney, stone or findings related to gastrointestinal paresis on plain abdominal X-ray, fluid in various qualities that can be together with pyelocalicial dilatation in the periureteral, perinephric or peripelvic area on consecutive ultrasonographic examinations, changes in perfusion of renal interlobular arteries by Resistance Index (RI) and Pulsatility Index (PI) on color Doppler ultrasonography (USG) (5), and contrast extravasation to peripelvic, perinephric or retroperitoneal area on intravenous pyelography (IVP) or computed tomography (CT) (3,4,6).…”