Foreign bodies in the kidney; a review of the literature and reports of four additional cases.

Abstract

Foreign bodies in the kidney and renal pelvis are reported so rarely that we should be reminded of their clinical symptoms and roentgen signs. This subject is not discussed in standard textbooks and few physicians are well acquainted with the entity. A study of the Quarterly Cumulative Index Medicus reveals only 34 cases reported in detail. In several of these it was the radiographic examination that disclosed the cause of obscure septicemia or urinary symptoms. Twenty-six of the reports were available for review and 4 new cases will be reported. Foreign bodies may reach the kidney by one of three routes: through the urethra, bladder, and ureter; from the gastrointestinal tract; by means of external violence. It is well known that foreign bodies are frequently introduced into the urinary bladder. If the object is small enough, it is entirely possible for it to enter the ureteral orifice and ascend to the renal pelvis by means of antiperistaltic action of the ureter. A foreign body may be started on this path by an erotogenic act, by a mentally disturbed patient, or even during an operative procedure. A more frequent and more bizarre route is taken by the foreign body that is swallowed and eventually perforates the intestinal wall at the second portion of the duodenum or after entering the colon. The majority of foreign objects reach the kidney directly as a result of external violence. Postoperative drains should be included in this group, as well as bullets, shell fragments, needles, and explosion debris. Sex and Age Incidence: The 26 previously reported cases of foreign bodies in the kidney are summarized in Table I. Nineteen of the patients were males and 7 females, the preponderance of males being due to the inclusion of numerous war casualties reported in the foreign literature. The ages ranged from two to sixty-one years. The right kidney was involved in 15 instances and the left in 10. Etiology: As may be seen from the table, most of the foreign bodies reached the kidney directly by means of external violence. Of these, 10 were bullets or shell fragments, 2 were needles, 1 debris from an explosion, and 1 a fragment of a drain overlooked at the time of a pyelotomy. Eight patients swallowed objects which later reached the kidney. These included 3 bobby pins, 2 needles, 1 hairpin, 1 toothpick, and 1 wire clip. All of these entered the right renal pelvis. Six were shown to have perforated the second portion of the duodenum. It was presumed that the other 2 perforated the ascending colon to reach the right renal area. In one unusual case (No.5) a seed-bearing grass straw was found to be the cause of unexplained hematuria. It was considered that this had been introduced through the urethra, had passed through the bladder and then ascended the ureter to reach the left renal pelvis. In a similar case (No. 11) a single seed-bearing grass straw had been in the right renal pelvis for fourteen months.