Spontaneous Rupture of the Renal Pelvis During Pregnancy: A Case Report and Review of the Literature

Shoji, Shuichi; Okuma, Akiko; Fujita, Yasuyuki; Tamaka, Masatoshi; Nakano, Hitoo

doi:10.1055/s-2002-28489

Cited by 31 publications

(37 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. angiomyolipoma), or cysts.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

“…Anecdotally, Tang et al reported a case of iatrogenic rupture that became symptomatic on day two following a caesarean section, secondary to accidental placement of sutures through the left bladder wall obstructing the left ureteral flow [15]. Spontaneous rupture with no underling condition is a phenomenon observed more frequently on the right side [2,[10][11][12][13]. A possible explanation for this refers to the compression of the right ureter caused by the physiological dextrorotation of the gravid uterus or by the engorged right ovarian artery [16] or vein coupled with the hormonal ureteral atony [17].…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

“…The treatment method may depend on the rupture site and severity [12] and on the clinical situation: rupture of a septic urinary system and rupture of the renal parenchyma. The goals of treatment are to preserve renal function, relieve pain, allow the site of rupture to heal spontaneously [31] and promote safe progress of the pregnancy to full term and safe delivery with minimal disturbance for the baby.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

“…Nabi et al suggested an intermediate approach, starting with the placement of a retrograde catheter and careful clinical follow-up of the patient's overall condition, haematocrit and serial US, followed by open exploration in case of deterioration [5]. Despite the use of JJ stents for rupture of urinary tract in pregnancy [2,[10][11][12][13], the literature is lacking in consistent data to sustain this as a standard method of treatment. When a JJ stent is used the recovery tends to be 'restitutio in integrum' at one month after removal of the stent [11,22].…”

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%

Section: Discussion and Literature Reviewmentioning

confidence: 99%

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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“…Eine Divertikulitis, ein Ileus, eine perforierte Ulzera, eine ischämische Kolitis und Aortendissektionen sollten ebenso in die differentialdiagnostischen Überlegungen mit einbezogen werden [1].…”

Section: Introductionunclassified

Harnleitersteinbedingte Fornixruptur in der Schwangerschaft

Klasen

Robert

Heinen

et al. 2010

Urologe

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Fornix rupture during pregnancy is rare. To be able to initiate the optimal therapy it is important to distinguish the spontaneous fornix rupture from the rupture caused by an obstruction. We report on a patient in the 18th week of pregnancy with strong flank pain on the left side. By means of MR urography the diagnosis of a left fornix rupture due to an obstructive stone could be made. A double-J catheter was placed in the left ureter and the patient received oral antibiotics.

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Urologic Emergencies

Augustin¹

2018

Acute Abdomen During Pregnancy

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Spontaneous Rupture of the Renal Pelvis During Pregnancy: A Case Report and Review of the Literature

Cited by 31 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

Harnleitersteinbedingte Fornixruptur in der Schwangerschaft

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