Spontaneous ureteric rupture, a reality or a faux pas?

Rupture of the urinary collecting system with or without any perinephric extravasation is an extremely rare occurrence and usually known to occur following an obstructive pathology. Spontaneous or non-traumatic rupture, in the absence of any distal obstruction, though reported in literature, is not yet a proven entity and needs to be distinguished from physiological forniceal rupture, to validate its occurrence. Our case illustrates that spontaneous ureteric rupture does exist and requires a high level of vigil for prompt diagnosis and early simple management.

A 65 year old non diabetic gentleman presented with a 2 day history of right sided severe abdominal pain with no history of any prior trauma, surgery, urinary retention or calculus disease. His ultrasound whole-abdomen was suggestive of increased liver echogenicity, but his contrast enhanced CT scan (CECT) documented a ureteric rupture, with leakage of contrast from the upper ureters, well away from the renal pelvis He was promptly managed with cysto-ureteroscopy, retrograde pyelography (RGP) and double-J (DJ) stenting. His post operative course was uneventful and he was discharged on the second post operative day, without event. An RGP at 6 weeks of follow up showed no contrast extravasation from the ureter and his DJ stent was removed without event.

Spontaneous ureteric rupture, in the absence of any inciting cause, is an entity which exists and is easily manageable, once diagnosed timely. Thus, the need to maintain a high index of vigil, in order to identify this clinically entity at the earnest, institute prompt treatment and hence ensure that a "spontaneous" rupture, doesn't become a "faux pas" in the true sense of the word.