Renal Rupture in a Preeclamptic Patient with Subsequent Abscess

Abstract

A 27-year-old black female, gravida II, para I, presented with symptoms of preeclampsia, blood pressure 174/96, and complaints of dysuria, hematuria, chills and fever, and left back and suprapubic pain. Cesarean section was opted because of cephalopelvic disproportion. During the next 9 days she noticed bright red blood after voiding not consistent with lochia. Prenatal urine cultures showed a Staphylococcus haemolyticus resistant to penicillin but susceptible to vancomycin. Cultures were negative for gonorrhea, chlamydia and HIV. Admission laboratory data revealed hemoglobin 13 gm, hematocrit 38%, platelets 271,000, WBC 14,000 and temperature 39.6°C. Urine and blood cultures grew gram negative rods. Pre-enhancement phase helical computerized tomography (CT) demonstrated dehiscence of the left kidney. The arterial corticomedullary phase, after administration of 120 ml of nonionic contrast medium, showed nonenhancing, nonviable tissue elements or blood clots in a low density fluid collection extending from the mid pole of the kidney into the perirenal space (part A of figure). Enhancement of parenchymal margins on CT suggested viability and good progno