An Unusual Radiological Emergency: Spontaneous Renal Pelvis Rupture Attributable to a Small Vesicoureteric Junction Calculus

Abstract

Abstract
Spontaneous rupture of the renal pelvis (SRRP) without prior trauma or medical intervention is a rare and diagnostically challenging condition that can mimic renal colic or other causes of acute abdomen. This report aims to highlight the importance of imaging in identifying SRRP secondary to distal ureteric obstruction. We describe a case of SRRP complicated by urinoma caused by a small vesicoureteric junction (VUJ) calculus. A 45-year-old male presented with worsening right-sided colicky abdominal pain. Initial bedside ultrasonography demonstrated moderate right hydronephrosis, raising suspicion of obstructive uropathy. Subsequent non-contrast computed tomography (CT) revealed a loculated retroperitoneal fluid collection and a small right VUJ stone, while contrast-enhanced CT in the delayed excretory phase demonstrated contrast extravasation from the right renal pelvis, confirming SRRP with associated urinoma. The patient underwent retrograde pyelography and right double-J ureteral stent placement, followed by antibiotic therapy, with complete clinical recovery. Although uncommon, SRRP should be considered in patients presenting with atypical renal colic, and delayed excretory-phase CT imaging is essential for accurate diagnosis and appropriate management.

Keywords Spontaneous, renal pelvis rupture, stone, Computed Tomography (CT)