Spontaneous renal rupture in pregnancy

Middleton, Anthony W.; Middleton, George W.; Dean, Leona K.

doi:10.1016/0090-4295(80)90543-9

Cited by 24 publications

(26 citation statements)

References 12 publications

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“…According to Middelton et al and Meyers et al the patients with pregnancy associated ruptures may fall into three categories: (1) patients with no condition other than pregnancy, (2) patients with non-tumoral structural disease of the urinary tract and (3) patients with rupture of a renal tumour [8,9]. Most of these ruptures are associated with different underlying conditions of the kidneys or upper urinary collecting system [2,[10][11][12][13][14] such as infections, scars, congenital structural abnormalities, malignant or benign tumors (i.e.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

“…The advantages of a JJ stent are: pain relief and free drainage, facilitating the closure of the communication between the pelvicaliceal system and perinephric space [5]. Other authors recommend an aggressive approach with rapid kidney exploration, drainage of the perinephric collection and nephrostomy placement [8]. This may be advocated especially in the case of a large rupture where a significant amount of urine and blood leaking into the perirenal space may progress to chemical/infective peritonitis if dissection of the retroperitoneal fascial planes continues [2] forming a retroperitoneal urinoma, haematoma or abscess which may spill into the peritoneal cavity [10].…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

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Spontaneous Non-traumatic Upper Urinary Tract Rupture in Pregnancy: Case Report and Literature Review

Efrimescu¹

2013

Emergency Medicine

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BackgroundLoin/flank pain in pregnancy is a common presentation to the Emergency Department (ED). There are a wide range of causes: medical, surgical, urological, obstetrical and gynaecological, but the predominant cause is acute hydronephrosis [1]. Hydroureteronephrosis is frequently associated with pregnancy and on rare occasions can progress to rupture of the urinary tract. This paper describes the case of a young female who developed an initial rupture of the left ureter, progressing following admission to develop symptoms on the right side. Also we have included a narrative review of the literature on this subject. To date, we believe, this is the first case report of a patient with bilateral symptomatic upper urinary tract hydroureteronephrosis. Case PresentationA 31 year old white European primigravida (28 weeks gestational age) with an uncomplicated pregnancy presented to the Emergency Department (ED) complaining of severe progressive left flank pain. The symptoms had commenced approximately 2 hours prior, whilst travelling by train, with gradual onset of colic pain of her left groin, worsening and ascending to the left flank and renal angle. Her past medical history included an episode of left pyelonephritis four years previous, bilateral breasts reduction two years ago and mild eczema which improved with progression of her pregnancy. She had no allergies and was not on any current medication. There was no family history of significance. On examination she was alert and oriented (GCS 15/15), not pale or cyanotic, anxious, restless, and complaining of severe pain (10/10 on numeric pain rating scale). Her body temperature was normal (36.6°C), with mild tachycardia (110 bpm), BP 140/105 mmHg, respiratory rate 17 breaths/minute, SaO 2 96% on room air and a capillary refill time < 2 sec. Percussion tenderness was elicited of the left loin. Her uterus had a normal height for the gestational age; there was no vaginal discharge or bleeding. Foetal movements were present with a heart rate of 120 bpm. The remainder of the clinical exam was unremarkable. An 18 G Intravenous (IV) cannula was inserted and baseline bloods investigations drawn for full blood count, group and screen, urea and creatinine, electrolytes, glucose, liver function test's, "C" Reactive Protein (CRP) and Venous Blood Gas (VBG). She was initially managed with opioid analgesia (pethidine), intravenous paracetamol and maintenance fluids (0.9% NaCl). Shortly after her pain score subsided to 3-4/10.No free fluid or other abnormalities were revealed by an ED Ultrasound (US). A bed side urinalysis revealed a moderate amount of blood, but negative for nitrites and leukocytes. Her VBG and glucose were normal.Based on the clinical presentation and microscopic haematuria a provisional diagnosis of renal colic secondary to a possible migrant renal calculus was established.Laboratory blood results revealed an elevated WBC (14.5×10 9 /L) with mild neutrophlia (11.8×10 9 /L) and elevated CRP (8.3 mg/L). Urea, creatinine, LFT's and electrolytes were normal. P...

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Section: Discussion and Literature Reviewmentioning

confidence: 99%

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Spontaneous Non-traumatic Upper Urinary Tract Rupture in Pregnancy: Case Report and Literature Review

Efrimescu¹

2013

Emergency Medicine

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“…Spontaneous rupture of the renal parenchyma or renal pelvis during pregnancy has been reported [6,8]. Spontaneous rupture of the renal pelvis in a single kidney has also been reported [9].…”

Section: Discussionmentioning

confidence: 95%

“…This extravasation is seen in excretory urography performed with external compression and resolves spontaneously [5]. A true rupture of the renal pelvis results in urine extravasation into the retroperitoneal space [6]. In rupture of the renal pelvis, lack of blood loss and lack of urinary symptoms are frequently reported [2].…”

Section: Discussionmentioning

confidence: 96%

Spontaneous rupture and emergency repairment of the renal pelvis

Hurі¹,

Ayyıldız²,

Nuhoğlu³

et al. 2007

Int Urol Nephrol

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A case of spontaneous rupture of the renal pelvis is very rare and unusual occurrence. Our case was a young woman who did not present with any disease that was a factor for pelvic rupture. The diagnosis was confirmed by abdominopelvic CT, and emergency repair of the renal pelvis was performed and a ureteral stent was inserted. Appropriate antibiotherapy was ordered, and the recovery was rapid. The differential diagnosis of this ease is discussed and the literature is reviewed:

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“…Elle peut survenir dans trois circonstances [85] : rupture spontanée sans cause, rupture de la voie excrétrice liée à une obstruction, rupture rénale secondaire à une tumeur, le plus souvent un angiomyolipome. Cliniquement, la rupture spontanée se manifeste par une douleur lombaire ou abdominale avec empâtement de la fosse lombaire et parfois choc hémorragique.…”

Section: Rupture Ré Nale Spontané Eunclassified

Focus: urological emergencies during pregnancy

Hermieu

2007

Pelv Perineol

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En raison de modifications anatomiques, physiologiques et fonctionnelles des voies urinaires, la grossesse peut être responsable de nombreuses pathologies urologiques s'exprimant parfois dans un contexte d'urgence et dont certaines peuvent menacer le pronostic vital materno-foetal. L'état de grossesse rend le diagnostic souvent plus difficile car de nombreuses investigations, dont certaines radiologiques, sont déconseillées chez la femme enceinte. Les possibilités thérapeutiques sont limitées, de nombreuses molécules ou certaines procédures chirurgicales étant contre-indiquées ou présentant un risque de déclencher le travail ou d'être délétères pour le foetus. Entre le confort de la patiente et le développement normal du foetus, des compromis sont parfois nécessaires. Le rapport bénéfice/ risque doit être particulièrement bien analysé ce qui nécessite une parfaite connaissance des particularités des pathologies urologiques chez la femme enceinte.L'incidence de la lithiase urinaire au cours de la grossesse est de l'ordre de 1/1500. Elle survient préféren-tiellement au deuxième et troisième trimestres, se manifestant surtout par une lombalgie et/ou une hématurie, mais la symptomatologie est parfois trompeuse. Si sept à huit calculs s'éliminent spontanément, un geste urologique est parfois nécessaire, l'attitude classique étant d'assurer, par un cathéter double J ou une néphrostomie percutanée, le libre écoulement des urines, le traitement définitif du calcul étant réalisé après l'accouchement.Les infections urinaires sont fréquentes au cours de la grossesse et peuvent se présenter sous trois aspects : bactériurie asymptomatique, cystite aiguë, pyélonéphrite aiguë. Une bactériurie non traitée induit un risque de pyélonéphrite de 20 à 50 %. Entre traitement minute et traitement classique de sept jours, il n'existe pas de consensus sur la durée optimale de traitement d'une cystite aiguë. La pyélonéphrite nécessite une antibiothérapie (souvent une céphalosporine de troisième génération) de 10 à 14 jours. Le risque de récidive d'infection urinaire nécessite une surveillance mensuelle des urines.La rupture rénale spontanée est une complication rare au cours de la grossesse. Elle peut survenir dans trois circonstances : rupture spontanée sans cause, rupture de la voie excrétrice liée à une obstruction, rupture secondaire à une tumeur (angiomyolipome). L'échographie est essentielle au diagnostic. La prise en charge va de la simple surveillance, au drainage des urines et/ou de la collection périrénale. Le recours à une néphrectomie en urgence est exceptionnel.Le placenta percreta envahissant la vessie est une variante exceptionnelle du placenta accreta. Il est favorisé par l'existence de cicatrices utérines favorisant la pénétra-tion de villosités placentaires dans le myomètre et le détrusor. Une hématurie n'est notée pendant la grossesse qu'une fois sur trois. La cystoscopie est souvent peu contributive. Lorsque ce diagnostic est évoqué, la biopsie endoscopique de la lésion doit absolument être évitée en raison du risque h...

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Spontaneous renal rupture in pregnancy

Cited by 24 publications

References 12 publications

Spontaneous Non-traumatic Upper Urinary Tract Rupture in Pregnancy: Case Report and Literature Review

Spontaneous Non-traumatic Upper Urinary Tract Rupture in Pregnancy: Case Report and Literature Review

Spontaneous rupture and emergency repairment of the renal pelvis

Focus: urological emergencies during pregnancy

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