Spontaneous ureteral rupture caused by iliac aneurysm: a case report

Abstract

BackgroundRupture of the ureter with extravasation resulting from an iliac aneurysm is extremely rare. Herein, we report a case of ureteric rupture with urinary extravasation secondary to an iliac aneurysm.Case presentationAn 80-year-old man was admitted to our hospital for sudden onset of severe abdominal pain. Contrast-enhanced computed tomography demonstrated a large left internal iliac aneurysm (6.5 cm in diameter) and a ureteric rupture with leakage of contrast media from the left ureter, indicating a spontaneous ureteral rupture. The patient was treated with placement of a ureteral double-J stent under endoscopic and X-ray fluoroscopic guidance and endovascular aortic repair. His postoperative course was uneventful and he was discharged on postoperative day 20. A computed tomography scan at 2 weeks after surgery showed no contrast extravasation from the ureter or end leak.ConclusionCombination treatment with ureteral and endovascular stenting is effective in avoiding aneurysmal rupture and the serious consequences of a ureteral rupture, which include a perinephric or retroperitoneal collection, abscess formation, subsequent urosepsis, and graft infection.

CT Evaluation of the Rupture of the Proximal Collecting System by Distal Ureteral Microlithiasis-Literature Review and Case Report

“…Serra RM, et al [15] reported that ureteral obstruction does not occur from the bulging of the aneurysm itself, but rather from the perianeurysmal inflammatory and fibrotic processes. However, with a rapid expansion of an aneurysm with impending rupture, the bulge might induce ureteral extravasation before the compensatory mechanisms of the ureter can function [14]. Our patient had a small left renal artery aneurysm without associated inflammatory characteristics and with-out fibrosis, so it cannot correlate the SUR with the presence of aneurysm.…”

“…Sato H, et al [14] in 2018 reported a case of SUR caused by iliac aneurysm. The majority of ureteral obstruction cases involve inflammatory aneurysms or retroperitoneal fibrosis associated with perianeurysmal fibrosis that ultimately results in the structural compromise of the urinary tract.…”

Spontaneous Urinoma Without Trauma or Obstruction in a 64-Year-Old Female

“…The injury is usually identified during the procedure and is repaired prior to significant urinoma development. Following this, less than 4% of penetrating traumatic insults and of 1% blunt traumatic insults resulted in ureteral injuries [1][2][3][4][5][6]. Because of the infrequency in traumatic presentation and the general origin being surgical intervention, it is a rare presentation in the ED.…”

“…A review of PubMed studies suggests that there are three general origins for a urinoma: an obstructive process in addition to the already mentioned traumatic incidents or iatrogenic origins. Obstructive processes can include ureterolithiasis, retroperitoneal fibrosis, or intra-abdominal mass effect [3][4].…”

Surgical and Endovascular Management of Isolated Internal Iliac Artery Aneurysms: A Systematic Review and Meta-Analysis

“…Additional remarkable treatment modalities and techniques which may be found in case reports or small case series are: retrograde trans-gluteal approach for embolization [24][25][26] parallel stent-graft technique for IIIAA exclusion 27,28 deployment of an iliac branch device to exclude the hypogastric aneurysm [29][30][31][32] endovascular exclusion exploiting the distal branches of the hypogastric artery as landing zones 33 Excluded noteworthy papers regarding clinical presentation-besides what we described in our qualitative synthesis-included: ureterohydronephrosis, ureteral rupture or haematuria [34][35][36][37] sciatic pain 38 arteriovenous fistula 39,40 deep venous thrombosis and pulmonary embolism 41 ileus, or bowel obstruction 42,43 aortoenteric fistula 44,45…”