title: Intraperitoneal rupture of the ureter as a cause of generalized peritonitis: report of a case.
abstract: We report a rare case of generalized peritonitis caused by nontraumatic, intraperitoneal rupture of the ureter. An 80-year-old woman with a history of bilateral vesicoureteral reflux and long-term urethral indwelling catheter drainage presented with a very distended abdomen. Computed tomography showed massive ascites and intraperitoneal free gas. We performed an emergency laparotomy, assuming a gastrointestinal perforation; but could not find a cause of generalized peritonitis. Postoperatively, she presented with anuria and massive peritoneal drainage. The findings of a cystogram confirmed intraperitoneal ureteral rupture. She was managed successfully with ureteral stenting. The diagnosis of this condition requires a high degree of clinical suspicion, along with radiographic evidence and peritoneal fluid analysis. Image-guided interventions play a crucial role in the management of ureteral urine leaks after a correct diagnosis has been made.
authors.affiliation: Department of Surgery, Ayabe Municipal Hospital, Kyoto, Japan.
authors.forename: Tomo
authors.initials: T
authors.lastname: Osako
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kounosu
authors.forename: Tsunehisa
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Ikuya
authors.initials: I
authors.lastname: Fujiwara
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Sawabe
authors.forename: Masaru
authors.initials: M
authors.lastname: Mori
authors.forename: Haruki
authors.initials: H
authors.lastname: Ito
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Takada
authors.forename: Shuji
authors.initials: S
authors.lastname: Shirakata
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D002408:Catheters, Indwelling; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D010537:Peritoneum / Q000473:pathology*; D010538:Peritonitis / Q000175:diagnosis / Q000209:etiology*; D012421:Rupture / Q000150:complications*; D014513:Ureter / Q000293:injuries* / Q000473:pathology; D014570:Urologic Diseases / Q000150:complications