Spontaneous forniceal rupture: Can it be treated conservatively?

Abstract

Context:Spontaneous forniceal rupture is one of the possible complications of urolithiasis. The mechanism of forniceal rupture is not well explained in the literature. Most of the cases presented with sudden onset of acute renal colic and diagnosed by noncontrast CT (NCCT). Until now there is no solid consensus about the ideal management of such a condition.Aim:To study indications and validity of conservative management of spontaneous caliceal rupture.Settings and Design:This is an observational prospective study.Materials and Methods:All cases diagnosed as spontaneous forniceal rupture in our departments from 2011 to 2015 were enrolled. All cases were diagnosed with NCCT or CT-Urography.. Non complicated patients were primarily managed conservatively. Intervention (DJ stent insertion, nephrostomy tube insertion, or urgent ureteroscopy) was reserved to complicated cases or solitary kidney. Drainage of urinoma was done in cases with sizable urinoma (more than 100 ml3).Results:A total of 40 patients: Twenty eight (70%) patients had normal serum creatinine level at presentation, while 12 (30%) patients had elevated serum creatinine. Twenty three (57.5%) patients were successfully managed conservatively, their mean size of stone was 6.2 ± 2 mm and the hospital stay was 3.1 ± 1.9 days. Eighteen patients (42.5%) underwent interventions. Their stone size was 4.5 ± 2.1 mm and the hospital stay for the interventional group was 4.2 ± 1.8 days.Statistical Analysis Used:Mann-Whitney test was used for testing difference between means because the data groups are not parametric. Otherwise, simple descriptive statestics were used.Conclusion:Spontaneous forniceal rupture is more likely to occur with smaller distal ureteric stones. Conservative management is a valid option in non-complicated cases. Intervention should be reserved to complicated cases or cases with sizable urinoma.

Spontaneous renal pelvis rupture: a case report

“…The symptomatology of SRPR, in the beginning, is similar to renal colic, an acute pain in the lower back, but when the fornix breaks this disappears due to the decrease in intraluminal pressure. Later, the symptoms are secondary to the urinoma and range from asymptomatic to mimicking an acute abdomen with peritoneal irritation and abdominal distention, nausea, and vomiting, making it difficult to diagnose without imaging [7]. In our case, the patient developed pain associated with abdominal distention and nausea.…”

“…Active treatment is made by placing a ureteral stent, which can be performed retrograde or antegrade, in our case the ureteral stent was placed retrograde. The stent drains the urine from the kidney to the bladder and prevents the urinoma progression, and promotes the healing of the urothelial tissue [7]. Conservative management has great results, but it should not be chosen when the patient with fever, leukocytosis, positive urine cultures, emesis, or renal dysfunction [8].…”

Spontaneous bilateral renal pelvis rupture during CT in the absence of urinary tract obstruction: case report

“…superimposed infection, kidney injury), risk factors for complications (e.g. sizeable urinoma 100 mL or larger) or a solitary kidney [10][11][12]. The detection of further contrast extravasation or unresolving urinoma in this case would have prompted consideration of drainage and urinary diversion.…”

Spontaneous rupture of the fornix due to a ureteral lithiasis of 3 mm causing a urinoma: report of an original case

“…However, the reference examination is a CT scan with late time acquisition. It can accurately show the extravasation of the contrast agent and the exact site of rupture [ 6 ]. In this case, ultrasonography has shown its limitations; since it objectified hydronephrosis but not the effusion.…”