Migración tardía de mondadientes dentro de vejiga: con presentación inicial de urosepsis e hidronefrosis / Late migration of a toothpick into the bladder: initial presentation with urosepsis and hydronephrosis

OBJETIVO: La migración de cuerpos extraños que son ingeridos desde el aparato digestivo y fistulizados a vías urinarias, es poco frecuente. Nuestro objetivo es presentar un caso de un paciente con urosepsis y migración tardía de un mondadientes a vejiga. MÉTODO: Paciente masculino de 78 años quien ingresó por urosepsis, presentado ureterohidronefrosis derecha inicialmente diagnosticado como ureterolitisis obstructiva. En las imágenes de tomografía la presencia del cateter femoral confluía con la cercanías del cuerpo extraño y permitió que se confundiera con litiasis urinaria y enmascarara el proceso. Se manejó con antibioticoterapia y colocación de catéter ureteral. La ureteroscopia ulterior evidenció compresión extrínseca sobre uréter distal sin presencia de litiasis ni lesiones intravesicales. Posteriormente el paciente presenta fiebre y en los nuevos estudios radiológicos reportan un cuerpo extraño intravesical, no evidenciado en estudios previos. La uretrocistoscopia evidencia un mondadientes que se introduce en vejiga y se extrajo endoscópicamente. RESULTADOS: Retrospectivamente se interpreta que el cuerpo extraño perforó tubo digestivo, migró hacia retroperitoneo y provocó el proceso obstructivo por inflamación periureteral, y condicionó la sepsis. Posteriormente, al superar el cuadro infeccioso y a la manipulación durante la ureteroscopia, el mondadientes logró migrar hacia la luz intravesical y hacerse evidente para el diagnóstico. CONCLUSIONES: La migración de cuerpos extraños desde el tubo digestivo a la vejiga ocurre raramente. El diagnóstico se realiza mediante estudios de imagen y requiere en ocasiones un cierto nivel de sospecha(AU)

OBJECTIVE: Migration of objects into the urinary tract from the digestive tract has been described. Our objective is to report the case of a patient with urosepsis and late migration of toothpick from the gastrointestinal tract into the bladder. METHODS: A 78 y/o male patient with uro-sepsis and hydronephrosis was admitted. The initial suspected etiological cause was obstructive ureteral lithiasis. CT scan showed hydronephrosis and a possible ureteral stone. However, a femoral catheter was in place near the toothpick location, which jeopardized the detection of the foreign body. Antibiotic therapy and placement of a ureteral stent were performed. Once infection subsided, ureteroscopy was carried out showing a slight extrinsic compression of the distal ureter. The patient was readmitted with urinary infection. New imaging studies showed a foreign body in the bladder, which was not evident previously. Cystoscopy showed a toothpick penetrating the bladder and it was removed. RESULTS: Retrospectively, we interpreted that the foreign body perforated the gastrointestinal tract, migrated to the retroperitoneum and caused upper urinary tract obstruction by inflammatory reaction in the periureteral tissues. Once infection was solved, ureteral manipulation by ureteroscopy may have caused the toothpick migration into the bladder. CONCLUSIONS: Migration of foreign bodies from the gastrointestinal tract into the bladder occurs rarely. They clinically present as a complicated urinary tract infection. Imaging studies make the diagnosis, and a high level of suspicion is required(AU)

Late migration of a toothpick into the bladder: initial presentation with urosepsis and hydronephrosis.

OBJECTIVE: Migration of objects into the urinary tract from the digestive tract has been described. Our objective is to report the case of a patient with urosepsis and late migration of toothpick from the gastrointestinal tract into the bladder. METHODS: A 78 y/o male patient with uro-sepsis and hydronephrosis was admitted. The initial suspected etiological cause was obstructive ureteral lithiasis. CT scan showed hydronephrosis and a possible ureteral stone. However, a femoral catheter was in place near the toothpick location, which jeopardized the detection of the foreign body. Antibiotic therapy and placement of a ureteral stent were performed. Once infection subsided, ureteroscopy was carried out showing a slight extrinsic compression of the distal ureter. The patient was readmitted with urinary infection. New imaging studies showed a foreign body in the bladder, which was not evident previously. Cystoscopy showed a toothpick penetrating the bladder and it was removed. RESULTS: Retrospectively, we interpreted that the foreign body perforated the gastrointestinal tract, migrated to the retroperitoneum and caused upper urinary tract obstruction by inflammatory reaction in the periureteral tissues. Once infection was solved, ureteral manipulation by ureteroscopy may have caused the toothpick migration into the bladder. CONCLUSIONS: Migration of foreign bodies from the gastrointestinal tract into the bladder occurs rarely. They clinically present as a complicated urinary tract infection. Imaging studies make the diagnosis, and a high level of suspicion is required.