Report of a Rare Case of Acute Abdominal Pain Post-partum: Spontaneous Ureteral Rupture.

Khan, P.; Ibrahim, DA.; Meena, V.

Report of a Rare Case of Acute Abdominal Pain Post-partum: Spontaneous Ureteral Rupture.

All Authors

Khan, P.

Ibrahim, DA.

Meena, V.

LTHT Author

Khan, Parkha

LTHT Department

Doctors' Rotation
Acute Internal Medicine

Publication Date

2024

Item Type

Case Reports
Journal Article

Abstract

Spontaneous ureteral rupture is a rare cause of acute abdominal pain, particularly unusual during pregnancy or the post-partum period. While pregnancy-related changes like ureteral compression and dilation may play a role, no definitive mechanisms have been established. Clinicians should suspect ureteric injury in post-partum patients with free pelvic fluid. Diagnosis relies on contrast-enhanced CT and cystoureteroscopy, with ureteral stenting being an effective management strategy. Our case is a 32-year-old primigravida (G1 P1) woman who presented with acute abdominal pain shortly after forceps-assisted vaginal delivery. Physical examination revealed right iliac fossa rebound tenderness. Laboratory tests showed elevated inflammatory markers, increased creatinine levels, and reduced estimated glomerular filtration rate (eGFR), indicating stage 2 acute kidney injury. Contrast-enhanced CT of the abdomen and pelvis demonstrated free-fluid collection with air foci and contrast extravasation in the vicinity of the distal segment of the right ureter, confirming ureteric rupture. The patient was treated with intravenous antibiotics and intravenous fluids. A multidisciplinary team meeting decided on definitive management through a nephrostomy procedure, which was unsuccessful. Subsequently, surgical repair was performed, involving a ureteral stent and a bladder patch placement to facilitate the healing of the ureteral tear. The ureteric stent was removed six weeks later via cystoscopy after a retrograde pyelogram confirmed complete healing of the tear. In conclusion, spontaneous ureteric rupture is a rare and underreported complication of vaginal delivery and is more common to occur in the renal fornices and upper ureter. CT urogram serves as the gold standard for diagnosis. Severe abdominal pain in the postpartum period can point to its occurrence. Treatment is usually by a nephrostomy or a ureteric stent with or without surgical reconstruction of the ureter.