The aim of presenting this case was that a spontaneous urinoma in the perinephric region because of long standing right ureteric calculus causing obstruction was noticed. This is not the common phenomenon and any aggressiveness to decompress or drain the urinoma via PCN would have been harmful.
Dr. F.M, 75 years of age, was suffering from generalized weakness, reduced appetite on and off fever and pain in right lumbar and iliac region. He is a known diabetic and hypertension and underwent Trans Urethral Resection of Prostate (TURP) in 2005. He is also a known case of bilateral renal calculus disease. Currently, he is a known to have right lower urinary calculus with right sided hydro-uretero-nephrosis. He also had significant anemia, Urinary Tract Infection and chronic azotemia.
Dr. F.M was received in a toxic condition and was treated aggressively to control his infection and was investigated.
Dr. F.M was subjected to Renogram and Renal scan on November 11, 2007 which revealed mild obstructive nephropathy pattern of left kidney following Intra Venous lasix intervention. Slightly enlarged hydro-nephrotic right kidney with moderate obstructive nephropathy. It also showed mild parenchymal dysfunction of the right kidney. His repeat Ultrasonography done on November 20, 2007 revealed large collection in the right sub capsular region and right perinephric region. Both kidneys showed increased echo texture suggestive of medical renal disease. A large calculus was also seen in the right lower 3rd of the ureter and a small calculus was also seen in the left kidney.
Dr. F.M was subjected to Cystoscopy and right renal Ureterorenoscopy on November 22, 2007. Right Ureteroscopy (URS) was done. The stone was localized and was fragmented with Swiss Lithoclast Master. The fragments were removed into the bladder and were subsequently washed out. A Double J Stent was kept. Dr. F.M recovered from the procedure uneventfully.
Further, post operatively Dr. F.M revealed a mass in the right lumbar region which presented more anteriorily. Hence, he was subjected to repeat sonography on November 23, 2007 which revealed large fluid collection with internal echoes with right sub capsular region and extending into the retro peritoneum. Few small calculi were seen in the right kidney with double J Stent in Situ. The fluid collection was source as it was seen pre-operatively.
Dr. F.M’s creatinine levels reduced from 2.9 to 1.9 in 6 days.
Dr. F.M had really shown a very interesting problem and we are quite sure that management given to him will help him recover. It would be most interesting to follow up with him after 2 months.
Dr. Dilip Raja
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