Iatrogenic fornix rupture caused during retrograde manipulation of the ureter: a case report
© Bannowsky; licensee BioMed Central Ltd. 2008
Received: 09 November 2008
Accepted: 17 November 2008
Published: 17 November 2008
Iatrogenic fornix rupture caused during retrograde manipulation of the ureter is a rather rare or rarely diagnosed phenomenon. A 22 year-old female patient presented with a fornix rupture following endoscopic ureteral stone extraction under uretero-renoscopy, the rupture having become symptomatic two days later.
The fornix rupture, a special form of the obstructive nephropathy, presents a rather rare and/or rarely diagnosed phenomenon. We report of a 22 year old female patient who was transfered to us after suspicion of a fornix rupture two days after receiving ureterorenoscopic extraction of an ureteral stone.
An ureterorenoscopy with extraction of an ureteral stone was performed on a 22 year old female patient after two unsuccessful attempts of extracorporeal shock wave lithotripsy. Dilatation of the upper urinary tract as well as peri- or intrarenal urinary extravasation did not exist before endoscopic stone removal.
On the second postoperative day the patient developed progredient symptoms with flankpain spraying into the right upper and lower abdomen. Therefore she was transfered to our clinic for further diagnostics and therapy.
Every supravesical obstruction might be a possible reason for developing a fornix rupture. The most common causes are obstruent ureter stones. 2–3% of all colics caused by stones are supposed to be followed by a fornix rupture . The second most common cause is the iatrogenic restriction of the ureter, i.e. due to gynecological surgeries. Further possible causes are restrictions through obstruent tumors or a traumatic event with chronic obstruction .
The iatrogenic caused fornix rupture through retrograde ureter manipulation is a rather rare or rarely diagnosed phenomenon, because after disobstruction of the upper urinary tract the rupture remains mostly asymptomatic. The urinary extravasation will be reabsorbed through the lymphatic system in the perirenal fat .
Requirement for a mild process, which justifies a conservative treatment, is the sterility of the urine. On the other hand, if the urine is infected, the risk of febrile to septic pyelonephritis with perirenal formation of an abscess increases dramatically. Approximately 10% of all perirenal abscesses are caused by urinay extravasation due to fornix ruptures . In these cases an operative treatment should be performed immediately.
Regular postoperative sonographic controls are absolutely necessary to diagnose an urinary extravasation in time to induce an appropriate therapy, especially if additive febrile symptomatic has become evident. Even in the case of a non-dilated upper urinary tract with a correct placement of the ureterstent after endoscopic uretermanipulation, this approach is recommended as well.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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