Spontaneous rupture of the fornix due to a ureteral lithiasi
Spontaneous rupture of the fornix is rare and may or may not be of traumatic origin. In a study conducted by Ercil et al on 43 patients, the lithiasis cause was identified in 74.4% of cases; in four patients (9.3%) no cause was found. The clinical presentation is varied. It may be mild flank pain, nausea, and vomiting, or an acute abdominal picture. Clinical presentations such as pyelonephritis, appendicitis, duodenal ulcer, and biliary colic(symptomatic cholelithiasis) have been reported.

From a diagnostic point of view, ultrasound can identify hydronephrosis, the presence of collections, or the presence of stones. However, the reference examination is a CT scan with late time acquisition. It can accurately show the extravasation of the contrast agent and the exact site of rupture. Immediate urinary diversion is essential for successful treatment. The definitive treatment of stones should be delayed until the rupture has healed completely. Open surgical procedures are rarely necessary for patients with PRRS due to stone disease. The shunt was performed as an emergency procedure, using a double J ureteral stent. Renal urine collected during endoscopic maneuvers was cloudy.

The prognosis varies according to the underlying pathology, renal lesion, site of rupture, and presence of infection. If untreated, this formed urinoma can lead to perirenal abscess formation, sepsis, retroperitoneal fibrosis, loss of renal function, and even death. Post-operative outcomes were favorable. This could be explained by the bypass that was done in the emergency room and the antibiotic therapy.

Spontaneous rupture of the pyelocalyceal cavities or the fornix is a rare emergency, rarely encountered in current urological departments, It is of multiple etiologies, it can be caused by a 3 mm calculus that can be expelled spontaneously or by therapy. In the face of hyper-Algic lumbar pain, ultrasonography knows is the definitive examination. The CT scan remains the examination of choice. Emergency treatment consists of a urinary diversion by double J ureteral stent or percutaneous nephrostomy. However, the etiological treatment must not be forgotten and must be done at a distance from the acute episode.

Source:https://www.sciencedirect.com/science/article/pii/S1930043321004428
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