Ureter Rupture From Ureterovesical Junction Obstruction in a Child

TL;DR

A child with a blocked ureter developed a rare rupture, leading to severe complications, highlighting the importance of regular medical follow-up.

Contribution

This case report highlights the rare complication of ureteral rupture in a child with untreated ureterovesical junction obstruction.

Findings

The child presented with acute abdominal pain and signs of ureteral rupture after a year of lost follow-up.

DMSA scintigraphy showed severely reduced function in the affected kidney.

Surgical intervention was required to repair the ruptured ureter.

Abstract

Ureteral rupture in children with ureterovesical junction obstruction (UVJO) is rare. We report the case of a five-year-old boy diagnosed with right UVJO who was lost to follow-up for one year and later referred to our department, presenting with acute abdominal pain. An abdominal computed tomography (CT) revealed right hydronephrosis, hydroureter, and unilateral ascites. Serum creatinine level significantly decreased within six hours, suggesting urinary ascites due to ureteral rupture. Dimercaptosuccinic acid (DMSA) kidney scintigraphy demonstrated significantly decreased function of the right kidney (16%) compared to the left (84%). Pediatric surgery revealed right UVJO with a ruptured distal right ureter, which was reconstructed surgically. As this case illustrates, routine follow-up of patients with congenital urinary tract obstruction is critical to avoid extreme morbidity.

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