Forniceal rupture and urinoma secondary to retroperitoneal fibrosis: a clinical case and literature review

Abstract

The most frequent site of excretory system rupture that is secondary to obstruction, usually arising from stone disease, is the renal fornix. Forniceal rupture and the formation of retroperitoneal fluid collections are rare forms of retroperitoneal fibrosis. Presented herein is the case of a man in the sixth decade of life that came to the emergency service because of abdominal pain. Computed tomography scan of the abdomen and pelvis revealed a slightly enhanced retroperitoneal soft tissue lesion that extrinsically enveloped and compressed the right ureter. A second image of lower density was observed in the excretory phase that proved to be a urinoma secondary to rupture of the ipsilateral renal fornix. A double-J catheter was placed to decompress the excretory system and systemic steroid therapy was given, with good response. Retroperitoneal fibrosis is an uncommon disease characterized by the development of inflammation and fibrosis in the retroperitoneal space. We describe herein two forms, idiopathic and secondary, the former being more frequent. Current evidence has associated the idiopathic variant with IgG4-related diseases.