Appendicitis Mimicking Urinoma: A Challenging Emergency Presentation Secondary to Ureteric Stone

Abstract

This article describes the case of a 38-year-old male who presented to the ED with three days history of gradually progressing right-sided lower abdominal pain, which had increased in severity two hours prior to his ED visit. The patient was anorexic but denied experiencing any fever, urinary malfunctions, or chills. Blood tests showed an elevated serum creatinine level of 123 umol/L and a high C-reactive protein level of 62 mg/L. Bedside point-of-care ultrasound (POCUS) imaging showed right-sided mild hydroureteronephrosis with surrounding perinephric fluid. Initially, based on the patient's presentation and clinical findings, appendicitis or ureteric colic was strongly suspected. CT of the abdomen with contrast revealed urinoma measuring 16 cm, and there was a 3.2 mm calculus in the distal part of the right ureter, with perinephric and periureteric fat stranding. This rare phenomenon requires prompt care. Delayed medical treatment may result in complications like hydronephrosis, abscess, distorted electrolyte levels, and gradual loss of renal function. Small urinomas are usually treated conservatively, while large-sized urinomas often require aggressive medical treatment. A drainage catheter under CT or ultrasound guidance may be done, and additional decompression and drainage may be needed with percutaneous nephrostomy tubes. The fluid and urine culture guide antibiotic treatment.

Urinoma Due to Spontaneous Rupture of the Renal Pelvis Mimicking Appendicitis

“…Spontaneous rupture of the renal pelvis (SRRP) and subsequently urinoma is an underreported condition in the literature and represents less than 1% of renal injuries [ 1 ]. Extravasation of urine without recent ureteric instrumentation, recent surgery, external trauma, or renal tumors is known as SRRP [ 2 ].…”

“…The manifestation of urinoma as the first sign of obstructive uropathy is rare and can easily be misdiagnosed as another condition that requires surgical intervention [ 1 , 3 , 4 ]. In this case report, a patient presented to the emergency department (ED) with symptoms of appendicitis but was later diagnosed with urinoma caused by an obstructive distal ureteric stone.…”