Internal Med Medical News about stone-induced ruptured calyx; horseshoe kidney

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Stone-induced ruptured calyx in a patient with a horseshoe kidney
JAAPA, 08/21/09

Adams CD et al. – This article illustrates a previously unreported case of a calyceal rupture caused by an obstructing calculus in a patient with a horseshoe kidney. The etiology of this patient's nontraumatic abdominal pain was unclear after a thorough history, physical examination, and routine laboratory studies. A CT scan of the abdomen clarified the diagnosis, demonstrat ing a horseshoe kidney with extravasation of urine from the renal pelvis and an obstructing calculus at the ureterovesical junction. Patients, even those with a relatively large amount of extravasated urine, may be managed conservatively (nonoperatively) if there is no ongoing obstruction and no sign of infection, as was the case with our patient after he spontaneously passed his ureteral calculus. Clinicians should be aware of the potential for UPJ obstruction and the increased incidence of renal calculi and urinary tract infections in patients with a horseshoe kidney, especially when evaluating complaints of abdominal pain.

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