Rupture of the renal pelvis complicating a renal colic: report of a case

Uropoietic system rupture resulting in either urinary ascites or retroperitoneal urinoma is a rare condition that may occur at any age. Although ruptures without predisposing factors are described, usually they are associated with obstructive uropathy and arise from an excessive intraluminal urinary tract pressure. Clinical presentation is aspecific, often indistinguishable from a simple renal colic, and the diagnosis in most cases delayed. Prognosis depends on underlying diseases, degree of renal damage, location of rupture, and infection occurrence. A 46-year-old white man presented to the ED with acute left flank pain that started 1.5 hours earlier. Anamnesis was negative for previous attacks of renal colic and stone disease. Before ED admission, he did not have any therapy. Patient was hemodynamically normal, but intense pain during triage assessment led to an immediate admission at the hospital. Clinical examination detected painful left hemiabdomen, with flank maximal tenderness without signs of peritonism. Fever was absent. Urine dipstick was positive for microhematuria. An immediate abdomen ultrasonography did not reveal urinary tract abnormalities, dilatation of canal system, urolithiasis, intraperitoneal fluid, masses, or aortoiliac aneurysms. Laboratory evaluation was unresponsive.