Spontaneous Forniceal Rupture in the Emergency Department

Authors : Mehmet Yorgun, Arif Mehmet Duran, Ramazan Sami Aktas, Osman Tas
Pages : 130-133
Doi:10.33706/jemcr.1695836
View : 131 | Download : 226
Publication Date : 2025-12-31
Article Type : Other Papers
Abstract :ABSTRACT INTRODUCTION Spontaneous rupture of the renal fornix and urine extravasation is a very rarely encountered condition in the practice of urological emergencies in emergency department admissions. CASE REPORT In this report, we present a 50-year-old woman who suddenly developed spontaneous fornix rupture and urine extravasation due to obstructive ureteral calculi. The patient presented to the emergency department with sudden onset of severe abdominal pain and nausea without any trauma. Except for the haemoglobin value (8.2 g/dl) in the complete blood count, all other laboratory and renal function tests were within the normal range. The patient had diffuse abdominal rebound and acute abdomen clinic on physical examination, the pain was very severe and intravenous contrast-enhanced abdominal computed tomography imaging was performed rapidly without waiting for the results of urine tests and without performing USG and radiography in order to recognise life-threatening pathologies early. Contrast-enhanced abdominal computed tomography showed a 5 mm diameter stone in the right proximal ureter and diffuse fluid compatible with urine density in the right pararenal area. In the present case, pain palliation was provided and ureterorenoscopy was performed after preop anaesthesia preparations were completed to control the symptoms and eliminate extravasation. In the operation,the stone in the proximal ureter was pushed back into the kidney. Retrograde renography was performed, revealing a rupture site in the lower pole fornix. A JJ catheter was placed, and the procedure was concluded. Follow-up ultrasound showed resolution of the perirenal fluid. In the 4th post operative week, the stone was removed via retrograde intrarenal surgery (RIRS). CONCLUSION: Spontaneous renal fornix rupture is a rare case in the emergency department, and since patients may present with various clinical symptoms and findings, it should always be considered in the differential diagnosis of patients presenting with abdominal pain. References: 1- Gökkaya CS, Baykam MM, Yahşi S, Bulut S, Aktaş BK, Memiş A. Spontaneous fornix rupture due to pbstructive ureteral stone. J Clin Pract Res 2014; 36(2): 91 93 doi: 10.5152/etd.2013.48 2- Eken A, Akbas T, Arpaci T. Spontaneous rupture of the ureter. Singapore Med J. 2015 Feb;56(2):e29-31. doi: 10.11622/smedj.2015029. PMID: 25715862; PMCID: PMC4350460 3- Kettlewell M, Walker M, Dudley N, De Souza B. Spontaneous extravasation of urine secondary to ureteric obstruction. Br J Urol 1973;45(1):8-14. 4- Paajanen H, Kettunen J, Tainio H, Jauhiainen K. Spontaneous peripelvic extravasation of urine as a cause of acute abdomen. Scand J Urol Nephrol 1993; 27(3): 333-6. 5- Searvance K, Jackson J, Schenkman N. Spontaneous Perforation of the UPJ: A Case Report and Review of the Literature. Urol Case Rep. 2016 Nov 26;10:30-32. doi: 10.1016/j.eucr.2016.11.007. PMID: 27920987; PMCID: PMC5128821. 6- Celik A, Altuntas M. Spontaneous Forniceal Rupture Identified by Point-of-care Ultrasound. J Coll Physicians Surg Pak. 2022 Oct;32(10):1341-1343. doi: 10.29271/jcpsp.2022.10.1341. PMID: 36205283. 7- Moore EE, Cogbill TH, Jurkovich GJ, et al. Organ injury scaling. III: Chest wall, abdominal vascular, ureter, bladder, and urethra. J Trauma 1992; 33:337-9. 8- Stravodimos K, Adamakis I, Koutalellis G, et al. Spontaneous perforation of the ureter: clinical presentation and endourological management. J Endourol 2008; 22:479-84. 9- Reva S, Tolkach Y. Spontaneous pelvic rupture as a result of renal colic in a patient with klinefelter syndrome. Case Rep Urol 2013; 2013:374973 10- Chen CC, Chang CH, Liu YL, Liu JH, Huang CC. A tiny stone induced ureteral rupture. Urolithiasis. Ann Acad Med Singapore 2010; 39:948-2. 11- Chapman JP, Gonzalez J, Diokno AC. Significance of urinary extravasation during renal colic. Urology 1987; 30(6): 541-5. 12- Kıraç M, Akyüz S, Üre İ, Batur AF, Çelik M, Tunç L. Rupture of the renal pelvis due to to ureteral stone. Turkish Journal of Urology 2007; 33(3): 369-71. 13- Holsten DR. Fornix rupture of the kidney as a complication of infusion pyelography. Rontgenblatter 1973; 26(10): 447-9. 14- Valero Puerta JA, Medina Pérez M, Valpuesta Fernández I, Sánchez González M. Surgical treatment of kidney pelvis spontaneous rupture. Arch Esp Urol 1998; 51(7): 728-30.
Keywords : Böbrek, spontan rüptür, üreter taşı

ORIGINAL ARTICLE URL