title: Perinephric Hematoma and Hemorrhagic Shock as a Rare Presentation for an Acutely Obstructive Ureteral Stone with Forniceal Rupture: A Case Report.
abstract: BACKGROUND
  Spontaneous perinephric hematoma (SPH) secondary to a forniceal rupture as the first presenting sign for an obstructive ureteral stone in a patient without history of urolithiasis has not been described previously.
  
  
  METHODS
  We report a 70-year-old Caucasian male patient who presented to our emergency room with fever, altered mental status, and left flank pain. He had a temperature of 103.3°F, tachycardia, but stable blood pressure. He had left flank tenderness. A computed tomography scan of the abdomen/pelvis with intravenous contrast revealed an intracapsular hematoma (13.3 × 10.0 × 6.4 cm) with an active bleeding and a 1.1 cm left proximal ureteral stone. The patient became quickly hemodynamically unstable and was taken for emergent exploratory laparotomy and left nephrectomy. An active bleeding was encountered secondary to a (2.4 × 2.0 cm) lateral capsular defect in the kidney.
  
  
  CONCLUSIONS
  Hemorrhagic/septic shock as a presenting sign for an obstructive ureteral stone may require an emergent nephrectomy in a hemodynamically unstable patient.
authors: Department of Urology, The Ohio State University Wexner Medical Center , Columbus, Ohio.
authors: Firas G
authors: FG
authors: Petros
authors: Department of Pathology, The Ohio State University Wexner Medical Center , Columbus, Ohio.
authors: Debra L
authors: DL
authors: Zynger
authors: Department of Urology, The Ohio State University Wexner Medical Center , Columbus, Ohio.
authors: Geoffrey N
authors: GN
authors: Box
authors: Department of Urology, The Ohio State University Wexner Medical Center , Columbus, Ohio.
authors: Ketul K
authors: KK
authors: Shah