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Spontaneous forniceal rupture in pregnancy.

Upputalla R, Moore RM, Jim B - Case Rep Nephrol (2015)

Bottom Line: Pregnancy is associated with ureteral compression due to increase in pelvic vasculature with the right ureter more dilated due to anatomic reasons.Hormones such as prostaglandins and progesterone render the ureter more distensible to allow for pressure build-up and an obstructive picture at the collecting system.We will discuss physiologic changes in pregnancies that predispose to this uncommon phenomenon and the most up-to-date management strategies.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology/Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA.

ABSTRACT
Forniceal rupture is a rare event in pregnancy. We report a case of a 26-year-old primigravid woman who experienced a forniceal rupture at 23 weeks of gestation with no inciting cause except for pregnancy. Pregnancy is associated with ureteral compression due to increase in pelvic vasculature with the right ureter more dilated due to anatomic reasons. Hormones such as prostaglandins and progesterone render the ureter more distensible to allow for pressure build-up and an obstructive picture at the collecting system. We will discuss physiologic changes in pregnancies that predispose to this uncommon phenomenon and the most up-to-date management strategies.

No MeSH data available.


Related in: MedlinePlus

CT scan of abdomen on admission. Blue arrow indicates presence of urinoma.
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fig1: CT scan of abdomen on admission. Blue arrow indicates presence of urinoma.

Mentions: We present a case of a 26-year-old pregnant female (G1P0) who presents at 23 weeks of gestation complaining of acute right sided flank pain for one day with no other associated symptoms such as fever or dysuria. Her physical exam was remarkable for right costovertebral angle tenderness. The patient's chemistry and hematologic laboratory values remained normal (Table 1). She was admitted with an impression of pyelonephritis and was started on antibiotics. Imaging studies including renal ultrasound, CT (Figure 1), and MRI were performed which revealed a right forniceal rupture with no evidence of nephrolithiasis. The initial aspiration of the fluid returned a sterile culture. She improved symptomatically with conservative therapy and was discharged home. However, four days later, she returned to a different hospital with similar complaints of right flank pain. A repeat CT scan revealed a urinoma measuring 17.5 cm. The urinoma was subsequently drained followed by the placement of a nephrostomy tube. The patient improved symptomatically and was discharged home. She was to follow up in outpatient urology, renal, and obstetric clinics. The patient continued to be symptom-free for the rest of the pregnancy and delivered at 37 weeks via a spontaneous vaginal delivery. The nephrostomy tube remained in through the remainder of the pregnancy with careful monitoring for infection; it was removed successfully two weeks postpartum.


Spontaneous forniceal rupture in pregnancy.

Upputalla R, Moore RM, Jim B - Case Rep Nephrol (2015)

CT scan of abdomen on admission. Blue arrow indicates presence of urinoma.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4306212&req=5

fig1: CT scan of abdomen on admission. Blue arrow indicates presence of urinoma.
Mentions: We present a case of a 26-year-old pregnant female (G1P0) who presents at 23 weeks of gestation complaining of acute right sided flank pain for one day with no other associated symptoms such as fever or dysuria. Her physical exam was remarkable for right costovertebral angle tenderness. The patient's chemistry and hematologic laboratory values remained normal (Table 1). She was admitted with an impression of pyelonephritis and was started on antibiotics. Imaging studies including renal ultrasound, CT (Figure 1), and MRI were performed which revealed a right forniceal rupture with no evidence of nephrolithiasis. The initial aspiration of the fluid returned a sterile culture. She improved symptomatically with conservative therapy and was discharged home. However, four days later, she returned to a different hospital with similar complaints of right flank pain. A repeat CT scan revealed a urinoma measuring 17.5 cm. The urinoma was subsequently drained followed by the placement of a nephrostomy tube. The patient improved symptomatically and was discharged home. She was to follow up in outpatient urology, renal, and obstetric clinics. The patient continued to be symptom-free for the rest of the pregnancy and delivered at 37 weeks via a spontaneous vaginal delivery. The nephrostomy tube remained in through the remainder of the pregnancy with careful monitoring for infection; it was removed successfully two weeks postpartum.

Bottom Line: Pregnancy is associated with ureteral compression due to increase in pelvic vasculature with the right ureter more dilated due to anatomic reasons.Hormones such as prostaglandins and progesterone render the ureter more distensible to allow for pressure build-up and an obstructive picture at the collecting system.We will discuss physiologic changes in pregnancies that predispose to this uncommon phenomenon and the most up-to-date management strategies.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology/Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA.

ABSTRACT
Forniceal rupture is a rare event in pregnancy. We report a case of a 26-year-old primigravid woman who experienced a forniceal rupture at 23 weeks of gestation with no inciting cause except for pregnancy. Pregnancy is associated with ureteral compression due to increase in pelvic vasculature with the right ureter more dilated due to anatomic reasons. Hormones such as prostaglandins and progesterone render the ureter more distensible to allow for pressure build-up and an obstructive picture at the collecting system. We will discuss physiologic changes in pregnancies that predispose to this uncommon phenomenon and the most up-to-date management strategies.

No MeSH data available.


Related in: MedlinePlus