SECONDARY RUPTURE OF THE RENAL FORNIX DUE TO SMALL URETERAL CALCULUS

Abstract

Objective: To report a rare case of renal fornix rupture secondary to ureteral obstruction caused by a tiny calculus, highlighting diagnostic and therapeutic aspects. Methodology: A descriptive, retrospective clinical case report based on data from medical records, laboratory and imaging tests, diagnostic and therapeutic procedures, and clinical follow-up. The case was selected due to the occurrence of forniceal rupture associated with a distal ureteral calculus measuring only 3 mm; such a small size makes the progression to collecting system rupture—following an initial conservative approach—uncommon. Data were collected retrospectively, organized chronologically, and analyzed descriptively. The case was approved by the Human Research Ethics Committee of the University of Vassouras (registration no. 8.565.275), and informed consent was obtained for the publication of clinical data and images. Case Details: A 63-year-old male patient presented with severe left flank pain, nausea, and vomiting. Computed tomography (CT) revealed a 3 mm left distal ureteral calculus and mild pelvicalyceal dilation. After approximately 24 hours, he returned with clinical deterioration; a repeat CT scan demonstrated urinary extravasation consistent with forniceal rupture. There was an elevation in creatinine, C-reactive protein, and lactate levels. Ureteroscopy and double-J stent placement were performed, resulting in a favorable outcome. Final Considerations: Forniceal rupture should be considered even in the presence of small calculi, especially when clinical deterioration occurs.