RETROPERITONEAL ABSCESS DUE TO A LUMBAR URINOMA EFFUSED INTO THE THIGH

Abstract

We are presenting the case of a retroperitoneal urinoma, secondary to a spontaneous pelviureteral junction rupture that effused to the thigh. A 45-year-old female patient known with lithiasis history admitted emergently in our clinic for right lumbar pain, right thigh pain and edema, fever and chills. Ultrasound examination and contrast CT revealed right side grade II hydronephrosis, fluid accumulation in the perirenal fat surrounding the kidney and descending downwards to the pelvis and upper thigh. At retrograde pyelography a right pelviureteral rupture could be observed. We preferred a minimal invasive approach and placed a right retroperitoneal drainage tube and a double-J stent, combined with broad spectrum antibiotics. After few days the patient complained for right thigh pain and movement impairment. She was immediately operated openly for right thigh abscess. Three days postoperative the general status of the patient improved and blood analyses normalized. Lumbar urinoma is a rarely encountered complication of urinary tract obstruction that can spread along the psoas muscle into the thigh. Minimal invasive treatment is recommended as first approach for urinary tract ruptures. In medical literature there are few cases of retroperitoneal abscesses effused into the thigh most of them with gastrointestinal origin.