Spontaneous Renal Forniceal Rupture Secondary to Fecal Impaction

Abstract

Rupture of the pyelocaliceal cavities or rupture of the renal fornix (RFR) with retro-peritoneal extravasation of urine is a rare urological complication most frequently associated with acute obstruction of the urinary tract by a calculus. It is a potential urologic emergency and management of a fornix rupture is not standardized. The aim of this case report is to highlight fecal impactation as a rare cause of spontaneous renal fornical rupture in an elderly woman and to present our management. We present the case of a 84-year-old Ms, admitted in emergency room with an occlusive syndrome associated with acute urinary retention. An initial biological assessment was carried out objectifying: Hemoglobin 16.4 g/dl, a biological inflammatory syndrome with leukocytes at 17,500/mm predominantly neutrophils at 14,670/mm, Platelets at 1,29,000/mm, PCR at 115 mg/l, TP at 79%, Creatinine at 196umol/l, urea at 21.8 mmol/m, serum potassium at 3.81 mmol/l, slight hyper natremia at 148 mmol/l and hypoproteinemia at 52.9 g/l. The contrast enhanced computed tomography realed a giant fecal impactation with hydronephrosis and rupture of the fornix in connection with the giant fecal impaction. Evacuation of the fecalome and the placement of double –J ureteral stent led to a clinical and biologic improvement of the patient’s health. The Computed Tomography (CT) review at 6 weeks showed a disappearance of the leakage of contrast product and the absence of dilation of the pyelo-caliceal cavities with a double -J stent in place. This case illustrates a conservative management of rupture of pyelocaliceal cavities.