Bilateral renal pelvis rupture following minor blunt injury

Abstract

Introduction. Ureteral and renal pelvis injuries due to external trauma are uncommon and account for less than 1% of all urologic traumas. Lesions of the renal pelvis are presented with minimal clinical symptoms. Hematuria and flank pain are the first clinical signs of traumatic injury of the urine collecting system, and excretory urograms and CT scans of the abdomen are reliable diagnostic means. Fever and pain herald urinoma and abscess formation, which if not treated frequently lead to loss of the affected kidney. Case report. A 68-year-old male patient presented at the emergency departement with a history of a fall four days before, after he tripped while walking. He complained about severe pain in the upper abdomen and lumbar region on both sides. The patient also presented with urinary retention. CT scan of the abdomen was performed, detecting rupture of the both renal pelvises. Bilateral ureteral J-J stents were installed. After one month a controlled CT scan was performed where no contrast extravasation was observed suggesting a complete healing of ruptured pelvices. Discussion. Renal pelvis rupture after blunt abdominal trauma is rare clinical entity. Common causes for such an event include congenitally abnormal kidneys, cystic conditions, hydronephrosis, history of renal transplantation and various iatrogenic procedures. In blunt abdominal trauma simultaneous rupture of bladder and pelvicaliceal system may occur if patient has chronically distended bladder in the presence of chronic retention. Rupture is reported to occur when intrapelvic pressures exceed 25 to 75mmHg and is seen most frequently at the fornices, possibly where the walls are the thinnest. Symptomatology is simmilar with renal colic, but sometimes could mimic an acute abdomen. Computed tomography does not confirm only contrast extravasation, but may also show the site of rupture. Smallsized urinomas may be resorbed spontaneously even without drainage. Currently, spontaneous renal pelvis rupture is successfully treated by ureteral stent implantation. If big urinoma is presented there may be need for percutaneus nephrostomy tube to evacuate the collection. Conclusion. Renal pelvis rupture can occur even in minor blunt abdominal traumas. Obtaining a good medical history and correct radiographic exams is mandatory. Ureteral stent installation helps renal pelvis to heal leading to normal function of the urinary system and is method of choice that results with positive outcome for the patient.