COVID-19 enfeksiyonu geçiren hastada böbrek pelvis rüpürünün eşlik ettiği spontan ciddi retroperitoneal kanama: olgu sunumu

Abstract

Spontan renal pelvis rüptürü nadir rastlanılan ürolojik olay olup idrarın extravazasyonuna neden olan bir durumdur. Sıklıkla üriner sistemde gelişen obstrüksiyonlara sekonder olarak pelvis içi basıncın artması sonucu gelişir. Spontan retroperitoneal hematom da yine benzer şekilde travma veya altta yatan bir patoloji olmaksızın ortaya çıkan retroperitoneal kanamalardır. Bu çalışmada 63 yaşında antikoagulan tedavisi alan Covid-19 tanılı bir bayan hastada, retroperitonda spontan olarak oluşan hematom ve hematomun basısına sekonder olarak gelişen spontan renal pelvis rüptürü olgusunu sunuyoruz. Bu olgu ışığında Covid-19 infeksiyonuna bağlı yaygın endotel hücre hasarının, spontan ciddi retroperitenal kanamaya ve eşlik eden renal pelvis rüptürüne neden olabileceğini vurgulamak istiyoruz. Nadir görülen durumlar olan spontan renal pelvis rüptürü ve spontan retroperitoneal kanamanın aynı anda aynı hastada görüldüğü literatürde ilk kez bildirilmektedir.

Keywords

• Antikoagulan tedavi
• Covit-19
• renal pelvis rüptürü
• retroperitoneal hematom
• uriner obstruksiyon

Spontaneous severe retroperitoneal hemorrhage with concomitant renal pelvis rupture during the course of COVID-19 infection: a case report

Abstract

Spontaneous rupture of the renal pelvis is a rarely encountered urological event that causes extravasation of urine. It often occurs as a result of increased intrapelvic pressure secondary to obstructions developed in the urinary system. Similarly spontaneous retroperitoneal hematoma is retroperitoneal hemorrhage that occurs without trauma or an underlying pathology. In this study, we present a case of spontaneous rupture of the renal pelvis that developed secondary to compression of the hematoma that occurred spontaneously in the retroperitoneum in a 63-year-old female patient who received anticoagulant therapy with the diagnosis of Covid-19 infection. In the light of this case, we would like to emphasize that widespread endothelial cell damage associated with Covid-19 infection may cause spontaneous severe retroperitenal bleeding and accompanying renal pelvis rupture. In which both the rarely encountered spontaneous rupture of the renal pelvis and spontaneous retroperitoneal bleeding are seen simultaneously in the same patient, is reporting for the first time in the literature.

Keywords

• Anticoagulant treatment
• Covid-19
• renal pelvis rupture
• retroperitoneal hematoma
• urinary obstruction

References

1. 1. Aggarwal G, Adhikary SD. Spontaneous ureteric rupture, a reality or a faux pas? BMC Urol 2016; 16(1):37-39. https://doi.org/10.1186/s12894-016-0158-2.
2. 2. Garg PK, Mohanty D, Rathi V, et al. Spontaneous rupture of the renal pelvis presenting as an urinoma in locally advanced rectal cancer. World J Clin Cases 2014; 2:108–110. doi: 10.12998/wjcc.v2.i4.108.
3. 3. Chen GH, Hsiao PJ, Chang YH, et al. Spontaneous ureteral rupture and review of the literature. Am J Emerg Med 2014; 32:772–774. DOI: 10.1016/j.ajem.2014.03.034.
4. 4. Pampana E, Altobelli S, Morini M, et al. Spontaneous Ureteral Rupture Diagnosis and Treatment. Case Reports in Radiology 2013; 12(4):1-4. DOI: 10.1155/2013/851859.
5. 5. Gershman B, Kulkarni N, Sahani DV, et al, Causes of renal forniceal rupture. BJU International 2011; 108(11):1909–1911. DOI: 10.1111/j.1464-410X.2011.10164.x
6. 6. Sayeed R, Nyamekye I, Kinder R. Unsuspected rectal adenocarcinoma causing a urinoma. Int J Urol 1997; 4:99–100. DOI: 10.1111/j.1442-2042.1997.tb00151.x
7. 7. Li Z, Beh JCY. Spontaneous bilateral renal pelvis rupture during CT in the absence of urinary tract obstruction: case report. BMC Urol 2020; 20(1):98-100. DOI: 10.1186/s12894-020-00669-4.
8. 8. Bernardino ME, Clennan BL. High dose urography: Incidence and relationship to spontaneous peripelvic extravasation. Ben J Roentgenol 1976; 127(3):373–376. DOI: 10.2214/ajr.127.3.373.

9. 9. Chien JC-W, Chang PY, Chan WP. Bilateral spontaneous peripelvic urinary extravasation. Kidney Int 2014; 86(2):448-451. DOI: 10.1038/ki.2013.514.
10. 10. Sunga KL, Bellolio MF, Gilmore RM, et al. Spontaneous retroperitoneal hematoma: etiology, characteristics, management, and outcome. J Emerg Med 2012; 43:e157-e161. DOI: 10.1016/j.jemermed.2011.06.006.
11. 11. Mondie C, Maguire NJ, Rentea RM. Retroperitoneal Hematoma. In: StatPearls [Internet]. Jan;Treasure Island (FL): StatPearls Publishing, 2021. Bookshelf ID: NBK558928.
12. 12. Ernits M, Mohan PS, Fares LG, et al. A retroperitoneal bleed induced by enoxaparin therapy. A retroperitoneal bleed induced by enoxaparin therapy. Am Surg 2005; 71: 430-433. PMID: 15986976.
13. 13. Salemis NK, Oikonomakis I, Lagoudianakis E, et al. Enoxaparin-induced spontaneous massive retroperitoneal hematoma with fatal outcome. Am J Emerg Med 2014; 32(12):1559. e1-3. DOI: 10.1016/j.ajem.2014.05.026.
14. 14. Zhang W, Zhao Y, Zhang F, et al. The use of anti-infl ammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): The experience of clinical immunologists from China. Clin Immunol 2020;214:108393.
15. 15. Scialpi M, Russo P, Piane E, Gallo E, Scalera GB. First case of retroperitoneal hematoma in COVID-19. Turk J Urol 2020 Sep;46(5):407-409. doi: 10. 5152/tud.2020. 20302.