Spontaneous ureteral rupture during pregnancy: a case report and literature review

Spontaneous ureteral rupture is a rare and emergent urological entity, with limited literature guiding its diagnosis and management. Its non-specific presentation can lead to delayed recognition, posing risks of severe complications such as urinoma, sepsis, and renal failure. Currently, there is limited experience regarding the diagnosis and treatment of spontaneous ureteral rupture during pregnancy. Herein, we present a case to illustrate effective diagnostic and therapeutic strategies for managing this rare but potentially life-threatening condition.

We present a 38-year-old woman at 25 weeks' gestation who presented with acute left flank pain and nausea. Initial ultrasonography revealed bilateral hydronephrosis without evidence of urolithiasis. Non-contrast magnetic resonance urography (MRU) confirmed discontinuity of the left upper ureter wall and perirenal fluid collection. Given the significant urinary extravasation and concerns about retrograde access, percutaneous nephrostomy was performed to prevent infection and preserve renal function. She remained stable throughout pregnancy and underwent an elective cesarean section at 35 weeks. Postpartum antegrade urography at 8 weeks demonstrated a patent ureter, and the nephrostomy tube was subsequently removed without complications.

Clinicians should consider spontaneous ureteral rupture as a differential diagnosis of abdominal pain during pregnancy, even in the absence of calculi. Repeated ultrasonography and MRU are safe and effective imaging modalities for diagnosis of spontaneous ureteral rupture in pregnant patients. Percutaneous nephrostomy can serve as a viable, effective and minimally invasive strategy that protects renal function and ensures maternal-fetal safety.