Catalin-Iulian Efrimescu, Derek Barton and David Mulvin
Background: Hydroureteronephrosis is one of the most common causes of flank pain in pregnancy, which on rare occasions can progress to rupture of the urinary tract.
Case presentation: A 31 year old previously healthy primigravida presented to the Emergency Department complaining of severe left flank pain. A provisional diagnosis of renal colic secondary to a possible migrant renal calculus was established based on an initial bedside Ultrasound (US), with no abnormalities, and moderate microscopic haematuria on urinalysis. A Magnetic Resonance urogram was performed and demonstrated perinephric fluid considered related to a pelvicaliceal rupture on the left side, with no evidence of calculi. A left percutaneous nephrostomy was performed, however 48 hours later she developed similar symptoms on the right side. A serial US exam revealed resolution of the hydronephrosis on the left side with persistent and progressing hydronephrosis on the right but no obvious rupture. A right percutaneous nephrostomy, then provided relief of symptoms. She made an uneventful recovery, was discharged home five days later and gave birth at 36 weeks to a healthy baby.
Conclusion: Spontaneous rupture of the upper urinary tract is a rare but significant complication of pregnancy that should be considered in the pregnant patients thought to be experiencing renal colic.