Spontaneous Rupture of the Fornix Following an Obstructive Distal Lithiasis of the Ureterovesical Junction: A Case Report and Literature Review

Abstract

Spontaneous rupture of the fornix is a rare urological pathology. The urinary tract obstruction is the most frequent etiology. We report here a case with short review of spontaneous rupture of the fornix due to distal lithiasis of the left ureter. The patient was 26 years old, with no particular pathological medical or surgical history, admitted for sudden and intense left low back pain, suffered from the past five days and increasing in intensity with onset of fever. The patient consulted a general practitioner on local clinic where an infectious assessment was requested before the prescription of anti-inflammatory and board spectrum antibiotic to decapitate a probable urinary tract infection. The pain did not disappear under the treatment. The decision was then to refer the patient for urology specialized care. Spontaneous rupture of the fornix is rare but must always be taken into account in the differential diagnosis of pathologies occurring in a febrile patient or presenting with an acute abdomen after episodes of acute low back pain. The often non-specific clinical symptoms will regress after the rupture except in certain cases like ours. The diagnosis is guided by the interrogation, suspected on ultrasound, and confirmed by computed tomography. With a low pressure system by urinary diversion and antibiotic treatment in some cases, the result is excellent. Endoscopic drainage for a better urinary diversion contributes to a good evolution of the patients.