| Author | Affiliation |
|---|---|
| Yalcin Golcuk, MD | Celal Bayar University, Department of Emergency Medicine, Manisa, Turkey |
| Murat Ozsarac, MD | Celal Bayar University, Department of Emergency Medicine, Manisa, Turkey |
| Emrah Eseroglu, MD | Celal Bayar University, Department of Emergency Medicine, Manisa, Turkey |
| Mehmet Bilgehan Yuksel, MD | Celal Bayar University, Department of Urology, Manisa, Turkey |
CASE
A 83-year-old man with a history of urinary stone disease presented to the emergency department with abdominal and right-sided flank pain. Examination demonstrated distended abdomen and right costovertebral angle tenderness. Vital signs were unremarkable, and laboratory evaluation showed a blood urea nitrogen level of 34.5 mg/dL and creatinine of 1.45 mg/dL. Urinalysis showed red blood cell count: 37/high power field (HPF); white blood cell count: 4/HPF; yeast cells: 4/HPF. Abdominal ultrasonography revealed a large cystic mass localized in the right side of the abdomen. Subsequent computed tomography (CT) of the abdomen and pelvis were also obtained
Figure 1
Dilated bowel (solid arrow) compressing the left atrium and lungs. Dilated colon contains stool and gas (dashed arrow).
.
DIAGNOSIS
Subsequent CT showed giant right-sided giant hydronephrosis and hydroureter with thinning of renal parenchyma due to obstruction by a ureteral stone. Patient consulted with department of urology and a percutaneous nephrostomy tube was placed. Approximately 4000 mL of urine was drained.
Symptomatic nephrolithiasis and hydronephrosis are frequently presenting clinical conditions, but giant hydronephrosis is an uncommon entity and a rare cause of urological emergencies. Giant hydronephrosis is defined as the presence of over 1000 mL of fluid within the adult renal collecting system. The most common cause of giant hydronephrosis is ureteropelvic junction obstruction, although stone disease, trauma, renal ectopy, and ureteral tumor have also been reported.1 Emergency physicians should be aware of this clinical presentation, especially in patients with urinary stone disease. A high index of suspicion and prompt management should avoid adverse outcomes.
Footnotes
Full text available through open access at http://escholarship.org/uc/uciem_westjem
Address for Correspondence: Yalcin Gulcuk, MD. Department of Emergency Medicine, Celal Bayar University. Email: dryalcingolcuk@gmail.com. 7 / 2014; 15:356 – 356
Submission history: Revision received September 2, 2013; Accepted February 10, 2014
Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.
REFERENCES
1 Grover CA, Crisp JG Giant hydronephrosis presenting as an acute abdomen. J Emerg Med. 2012; 43:e307-10
