Spontaneous Calyceal Rupture Due to a 3-mm Obstructing Ureteric Stone: A Case Report

Spontaneous rupture of the renal collecting system due to an obstructing ureteric stone is a rare, but significant complication. We present the case of a 27-year-old woman who presented with sudden, severe abdominal pain initially suspected to be of gynecological origin. Further investigation revealed a 3-mm obstructing stone at the vesicoureteric junction causing calyceal rupture. Rupture due to such small stones is rare and may be overlooked on non-contrast CT; however, the presence of perinephric edema or fluid should raise suspicion of this complication. The diagnosis was confirmed using contrast-enhanced CT, which demonstrated contrast extravasation. The patient was initially managed conservatively with analgesia, antibiotics, and alpha-blockers; however, persistent pain and the risk of worsening urinary extravasation necessitated cystoscopy and JJ stent placement. The postoperative recovery was favorable, and the patient was discharged on the second day. Follow-up ureteroscopy revealed no residual stones and the stent was successfully removed. This case highlights the importance of early diagnosis and timely urological intervention to prevent complications, such as urosepsis, urinoma, and acute kidney injury. While conservative management may suffice for small, passable stones, stenting is necessary in cases of obstructive uropathy, infection, or significant rupture. This report emphasizes the clinical presentation, diagnostic challenges, and management strategies of this rare but important condition. Prompt recognition and appropriate treatment are essential to achieve favorable outcomes.