Urinoma Due to Spontaneous Rupture of the Renal Pelvis Mimicking Appendicitis

Abstract

Spontaneous rupture of the renal pelvis (SRRP) with urine extravasation is rare. This condition is primarily associated with an obstructing ureteric calculus. It creates a diagnostic dilemma, especially when the clinical diagnosis can be inconsistent. Herein, we report a 49-year-old male patient who presented with abdominal pain for the past three days and was diagnosed with acute appendicitis. A computed tomography (CT) scan revealed a right renal pelvis rupture and urinoma secondary to an obstructive 4 mm ureterovesical junction calculi. The patient was successfully treated with double-J stent placement. In conclusion, even though SRRP is rare, emergency physicians should have knowledge regarding this condition, which often presents as an abdominal condition and may be misdiagnosed as another condition requiring surgical intervention. Radiologic investigations such as CT scans are useful methods in suspected cases of this condition in order to reduce unnecessary surgical intervention.

Keywords: appendicitis; extravasation; renal pelvic rupture; srrp; urinoma.

Figure 1. An abdominal computed tomography scan showing (A) a 4 mm calculus at the right vesicoureteral junction (arrow), (B) contrast leak from the renal pelvis (arrow), and (C) urinoma (arrow)

Figure 2. Site of pelvic rupture in the healing phase as seen on retrograde pyelography (arrow)