British Joiirnalof Urology (1975). 47, 488 0
Short Case Report
Intraperitoneal Rupture of Pyonephrosis A 55-year-old man was admitted as an emergency with peritonitis. Plain radiographs of abdomen did not show any abnormality. Laparotomy revealed generalised]peritonitis with a large, boggy retroperitoneal swelling situated lateral to the second part of the duodenum leaking pus into the peritoneal cavity. Initially this was thought to be due to a perforated peptic ulcer but the duodenum and pylorus looked normal. On exploration, the cavity extended up to the right paravertebral gutter, measuring approximately 22 x 12 x 10 cm. Peritoneal toilet was carried out and a drain inserted into the abscess cavity. The primary source of peritonitis did not come to light until the patient formed a sinus after drainage of a local abscess in the abdominal wall. An IVP showed no function on the right side and a sinogram (Fig.) through the drain site then revealed the source to be a hydronephrotic right kidney. Nephrectomy was performed. The patient made an uneventful recovery. Histology showed the renal tissue completely replaced by a thick-walled hydronephrotic sac, with pelvi-ureteric obstruction.
Comment Extraperitoneal rupture of the kidney is relatively common but intraperitoneal rupture leading to peritonitis is rare (Balas, 1971). Rupture is usually associated with a previous abnormality of the kidney, commonly hydronephrosis, as in this case. S . U. RAHMAN Burnley General Hospital, Burnley, Lancs BBIO 2PQ
References
Fig.
BALAS,P. et al. (1971). Peritonitis after spontaneous
rupture of pyonephrotic kidney into peritoneal cavity. American Journal ofSurgery, 121,612-613.
488
Short Case Report
Intraperitoneal Rupture of Pyonephrosis A 55-year-old man was admitted as an emergency with peritonitis. Plain radiographs of abdomen did not show any abnormality. Laparotomy revealed generalised]peritonitis with a large, boggy retroperitoneal swelling situated lateral to the second part of the duodenum leaking pus into the peritoneal cavity. Initially this was thought to be due to a perforated peptic ulcer but the duodenum and pylorus looked normal. On exploration, the cavity extended up to the right paravertebral gutter, measuring approximately 22 x 12 x 10 cm. Peritoneal toilet was carried out and a drain inserted into the abscess cavity. The primary source of peritonitis did not come to light until the patient formed a sinus after drainage of a local abscess in the abdominal wall. An IVP showed no function on the right side and a sinogram (Fig.) through the drain site then revealed the source to be a hydronephrotic right kidney. Nephrectomy was performed. The patient made an uneventful recovery. Histology showed the renal tissue completely replaced by a thick-walled hydronephrotic sac, with pelvi-ureteric obstruction.
Comment Extraperitoneal rupture of the kidney is relatively common but intraperitoneal rupture leading to peritonitis is rare (Balas, 1971). Rupture is usually associated with a previous abnormality of the kidney, commonly hydronephrosis, as in this case. S . U. RAHMAN Burnley General Hospital, Burnley, Lancs BBIO 2PQ
References
Fig.
BALAS,P. et al. (1971). Peritonitis after spontaneous
rupture of pyonephrotic kidney into peritoneal cavity. American Journal ofSurgery, 121,612-613.
488
