Content area
Full Text
Pediatr Nephrol (2004) 19:357360 DOI 10.1007/s00467-003-1383-y
BRIEF REPORT
Rolf Beetz Raimund Stein Petra Rohatsch Rita Brzezinska Jochen W. Th roff
Acute perirenal extravasation of urine in an infant with non-refluxing megaureter
Received: 20 February 2003 / Revised: 24 October 2003 / Accepted: 11 November 2003 / Published online: 18 December 2003 IPNA 2003
Abstract Perirenal extravasation of urine is a rare event in congenital uropathies, mostly observed perinatally in the case of infravesical obstruction. We describe a male infant with a primary non-refluxing obstructive left megaureter who developed an acute perirenal extravasation and ascites at the age of 4 weeks. After temporary upper urinary diversion, ureterocystoneostomy was successfully performed. Intraoperatively, the distal ureter showed an extremely narrow lumen over a distance of 3 cm. In the current literature, postnatal management of primary megaureters is preferably conservative. Our patient demonstrates an extremely rare complication demanding early surgical intervention.
Keywords Perirenal extravasation Urinoma Urine ascites Megaureter Congenital uropathy
Introduction Megaureter is a frequent reason for upper urinary tract dilatation detected by pre- or postnatal sonographic screening. Treatment is conservative in most cases as long as there are no clinical symptoms, progressive dilatation, or loss of renal function. In early infancy, megaureter can be a risk factor for complicated pyelone-
phritis or pyonephrosis. We observed acute perirenal extravasation of urine in a young infant occurring under close sonographic monitoring. To our knowledge, this is the first report of a spontaneous perirenal urine extravasation in an infant with a previously uncomplicated congenital megaureter detected by neonatal screening.
Case report
A male infant was delivered spontaneously in the 40th week of gestation after uneventful prenatal development. The clinical course during the newborn period was normal.
Postnatal sonography, routinely performed according to a regional screening program on the 10th day of life, showed a normal right kidney. On the left side, the renal pelvis was dilated up to 23 mm in transverse section. The thickness of the parenchyma was reduced to a minimum of 3 mm. Renal volume (calculated by the formula: length depth breadth 0.523) was 1604% of the weight-related normal. There was a megaureter with a prevesical diameter of 16 mm (Fig. 1a and b). At this time, clinical examination revealed no pathological results. Blood pressure was 85/44 mmHg....