ABSTRACT
Retroperitoneal fibrosis is a rare disease with a largely unknown aetiology, varying presentation, and is characterized by fibrous tissue formation in the retroperitoneal region. It causes entrapment and obstruction of retroperitoneal tubular structures, notably the ureters, and has been associated with autoimmune disorders. We report a 52-year-old male who was admitted to the emergency department with a seven-day history of lower abdominal pain, anorexia, and unintentional weight loss. Routine blood work revealed the patient to have acute kidney injury, and an unenhanced computed tomography scan of the abdomen showed bilateral hydronephrosis (grades 1 and 3 on the right and left, respectively) caused by a soft tissue mass in the retroperitoneal region. This mass was investigated with further imaging and a core biopsy, which confirmed retroperitoneal fibrosis. He is currently being planned for ureterolysis after a poor response to steroid therapy under the nephrology team. Urinary diversion was achieved with bilateral nephrostomies following unsatisfactory drainage with bilateral ureteric stents. This case highlights some of the difficulties that may be encountered in the management of retroperitoneal fibrosis.
ABSTRACT
Spontaneous or non-traumatic rupture of the renal tract is an infrequent presentation, and it is most frequently caused by ureteric obstruction. Rupture could occur at any level of the upper urinary tract. However, it is most common at the renal calyces and complications that could arise include; urinoma, and or hematoma collection which could progress to abscess formation and sepsis. We report a 77-year-old male patient who attended the emergency department following referral from his general practitioner with a 6-day history of progressively worsening left sided abdominal pain. Due to his co-morbidities, presenting blood pressure and age, he was suspected of having an aortic dissection or ruptured abdominal aortic aneurysm and subsequently had a CT (computed tomography) Angiogram. This showed extravasation of contrast from the left kidney with a 12 mm obstructing vesico-ureteric junction calculus necessitating urgent urology referral and prompt review. He was worked up for a ureteric double J stent insertion, however, the procedure was unsuccessful due to complex multiple urethral strictures. The patient subsequently had a nephrostomy inserted and was planned for optical urethrotomy, rigid cystoscopy, rigid/flexible ureteroscopy, and laser stone fragmentation of left obstructing vesico-ureteric junction calculus.
