Abstract
A 67-year-old female presented to the emergency department with acute-onset severe left flank pain as well as nausea and vomiting. Physical examination was notable for left-sided abdominal, flank tenderness, and costovertebral angle tenderness. Laboratory workup revealed an elevated lactate of 9.2 mmol/L and elevated serum creatinine of 1.14 mg/dL, with an estimated glomerular filtration rate of 53 mL/minute/1.73m(2). Urinalysis showed moderate leukocyte esterase with microscopy showing 12 white blood cells and three red blood cells per high-power field. CT of the abdomen and pelvis with intravenous contrast was notable for moderate amounts of left-sided perinephric and periureteric fluid without the presence of an obstructing calculus. Due to the amount of perinephric and periureteric fluid without associated nephrolithiasis, the differential diagnosis was broadened to include spontaneous ureter rupture as well as concern for malignancy. A delayed post-contrast CT scan of the abdomen and pelvis was obtained, which confirmed a spontaneous proximal and mid-ureter rupture. Spontaneous ureter rupture is a rare disease process with significant morbidity and mortality. It often poses a diagnostic dilemma due to a lack of clinical awareness and varied presentation. Diagnosis rests upon obtaining delayed post-contrast CT of the abdomen and pelvis. Currently, there are no standardized treatment guidelines, although most experts utilize minimally invasive endourological approaches in their treatment plans.