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Education - Case Histories |
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| F X Keeley, A G Timoney and T Porter
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| An 86-year-old male with a total hip replacement and diverticular disease presented with right-sided abdominal pain, dysuria, frequency and foul-smelling urine. On examination, he was diffusely tender over the right side of his abdomen with guarding. Urinalysis showed pyuria and bacteruria and a urine culture grew multiple organisms. Serum creatinine was normal. An ultrasound and CT scan of the abdomen and pelvis showed a large collection within the right renal pelvis. The right kidney parenchyma was thinned and irregular and contained low attenuation areas and tiny foci of calcification. The right ureter was not dilated and the left kidney appeared to be atrophic. A mass was demonstrated posterior to the bladder. |
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| The patient was suffering from right pyonephrosis with free fluid around the right liver that might represent sympathetic oedema or the result of a localised rupture. Percutaneous drainage was therefore postponed so 24 hours of IV antibiotics could be given to clear the sepsis. | |||
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| A percutaneous nephrostomy was placed in the right renal pelvis and thick pus was aspirated. | |||
| Two days later a right nephrostogram was undertaken and showed that the right renal collecting system was grossly abnormal and dilated with prominent clubbing of the calyces.No ureteric drainage was demonstrated. | |||
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| The patient developed temperatures in the range of 38.5oC and was re-evaluated by the general surgical team. A CT scan was performed with rectal contrast, demonstrating a colo-vesical fistula. He then underwent a Hartmann's procedure and had an uneventful recovery. | |||
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