AKUT PYELONEFRIT PDF

Pyonephrosis is an uncommon disease that is associated with suppurative destruction of the renal parenchyma in adults. Upper urinary tract infection and obstruction play a role in its etiology. Immunosuppression from medications steroids , diseases diabetes mellitus, AIDS , and anatomic variations pelvic kidney, horseshoe kidney may also be risk factors for pyonephrosis. Fever, shivering, and flank pain are frequent clinical symptoms. On physical examination, a palpable abdominal mass may be associated with the hydronephrotic kidney.

Author:Gom Gardaramar
Country:Myanmar
Language:English (Spanish)
Genre:Health and Food
Published (Last):22 December 2009
Pages:128
PDF File Size:14.76 Mb
ePub File Size:4.23 Mb
ISBN:139-4-92620-430-7
Downloads:97630
Price:Free* [*Free Regsitration Required]
Uploader:Tygojin



Peritoneal fistulization of a pyonephrosis is an extremely rare event which invariably leads to generalized peritonitis. This is a very rare case report on generalized peritonitis after spontaneous rupture of pyonephrosis. A year-old male patient from the rural part of Bale zone, Ethiopia, was admitted to Goba Referral Hospital with high-grade fever, diffused abdominal pain and abdominal distension. Initially, he experienced colicky and intermittent pain that made him stay at home for days.

With the diagnosis of generalized peritonitis, we resuscitated him with two bags of normal saline and one bag of ringer lactate intravenously.

During an abdominal ultrasound examination we identified that the left kidney was replaced by an abscess containing sac, and there was a huge intraperitoneal loculated abscess with internal septation and an associated free inter-loop and pelvic echo debris abscess.

When we performed an exploratory laparotomy, 1 L-thick abscess from the general peritoneum was aspirated and early fibrinous inter-loop adhesion was identified. In addition, there was a large retroperitoneal cystic abscess containing sac extended from the spleen up to the pelvic brim crossing the midline to the right side and bulged intraperitoneally. Furthermore, a 1. A total of 4 L of puss was removed from the left kidney.

As treatment, since the left kidney lost all function and became a pus-contacting sac, we performed a left-sided nephrectomy and abdominal lavage. Postoperatively, the patient had an uneventful recovery and was discharged from the hospital on the eighth day. We followed him for 6 months, and kidney function tests were normal and he did not develop any complications. This case report highlighted the importance of recognizing the possibility of underlying kidney rupture in a patient with generalized peritonitis.

Uretero-pelvic junction obstruction UPJO might be the possible cause of pyonephrosis in our case. As a treatment, nephrectomy is a preferable option when the affected kidney is not fully functional and the contralateral kidney is normal. The accumulation of purulent exudate in the hydronephrotic collecting system and abscess formation constitute the pathophysiology of pyonephrosis.

Antibiotics have no effect in pyonephrosis unless the pus is surgically drained. Percutaneous nephrostomy and urethral catheter insertions are, therefore, necessary. In addition, studies showed that percutaneous drainage is a fast, trusted and effective diagnostic and therapeutic method.

Radical nephrectomy can be the preferred treatment for a kidney that has lost most of its function if the contralateral kidney is normal. Nephrectomy has been found to have fewer complications compared to other treatments. He is a farmer and married with four children.

The patient had experienced left flank pain for the past 6 years. In addition, he had a history of reddish discoloration of urine during the flank pain episode. At the beginning of this condition, he did not visit any health care institution. After 3 weeks of the abovementioned symptoms, he was admitted to Ginnir hospital one of the rural hospitals in Ethiopia for 7 days with the diagnosis of left pyelonephritis and was given ceftriaxone 1 g intravenous IV bid and diclofenac 75 mg intramuscular im and as needed PRN.

Despite this, after 6 days of stay in the aforementioned hospital, he developed generalized abdominal pain, abdominal distension, constipation and high-grade intermittent fever.

Besides, the patient had pink conjunctiva and dry tongue. He had clear chest on auscultation, and first heart sound or lub S1 and second heart sound or dub S2 were well heard when the heart was assessed. Regarding the abdominal assessment, his abdomen was distended, had no visible peristalsis, and it did not move with respiration. Also there was hypoactive bowel sound, guarding, rigidity, direct and rebound tenderness all over abdomen.

The digital rectal examination showed empty rectum. He had a cold extremity. He had no history of diabetic mellitus, hypertension and he was neither a smoker nor an alcohol drinker. In abdominal ultrasound examination, we identified that the left kidney was replaced by an abscess-containing sac, and there was huge intraperitoneal loculated abscess with internal septation and associated free inter-loop and pelvic echo debris abscess. After 2 hours of IV fluid administration, he produced 80 mL of urine.

When we performed an exploratory laparotomy, 1 L-thick abscess from general peritoneum was aspirated, and early fibrinous inter-loop adhesion was identified.

In addition, there was a huge retroperitoneal cystic abscess-containing sac extended from the spleen up to the pelvic brim crossing the midline to the right side and bulged intraperitoneally.

Furthermore, about a 1. A total of 4 L of puss were removed out from the left kidney. As treatment, since the left kidney had lost full function Figure 1 and became a pus-contacting sac, while the contralateral kidney was still normal, we performed a left-sided nephrectomy and abdominal lavage. When we mobilized the left colon during the intraoperative phase, adhesion and renal pedicle were identified.

Therefore, double ligation of renal artery and vein together was done with silk number 1 as a result of inability to separate the renal artery and vein due to dense adhesion.

Then, the ureter was ligated and divided. The abdominal wall was closed after the lavage drain was left inside. We did not find any stones in the affected kidney and nearby structure.

Moreover, there was no evidence of tumor and tuberculosis from histopathologic examination of resected sample. Therefore, uretero-pelvic junction obstruction UPJO might be the possible cause of pyonephrosis of this case. Postoperatively, we put the patient on ceftriaxone 1 g IV bid, metronidazole mg IV tid, maintenance fluid, tramadol 50 mg IV qid and diclofenac 50 mg im tid.

He started sips on the third postoperative day. We removed the drain on the fifth postoperative day. The renal function test RFT performed in postoperative phase revealed normal range of serum electrolyte, and there was a normal amount of urine output.

The patient had an uneventful recovery and was discharged from the hospital on the eighth day after surgery. We followed him for 6 months, and he had a normal kidney function test and did not develop any complications. Written informed consent was obtained from the patient for publication of this case report.

Literature also supported that the most common symptoms of pyonephrosis are fever, chills and flank pain. We did not find any stones in the affected kidney, and UPJO might be the possible cause of pyonephrosis in our case. Our diagnosis was based on ultrasound. Different literature also confirmed the importance and even the indispensability of ultrasound and computed tomography in the diagnosis of pyonephrosis. The ultrasound finding in this patient indicated that the left kidney was replaced by an abscess-containing sac and a huge intraperitoneal loculated abscess with internal septation, associated free inter-loop and pelvic echo debris abscess.

Literature also supported that pyonephrosis might be differentiated from hydronephrosis on ultrasonography by the presence of debris, fluid—fluid levels and internal echoes in the collecting system. To treat the patient, left-sided nephrectomy and abdominal lavage were performed. The patient had no postoperative complications. Literature also supported that radical nephrectomy can be the preferred treatment for a kidney that has lost most of its function if the contralateral kidney is normal.

On top of this, nephrectomy has been found to have fewer complications compared to other treatments. This case report highlights the importance of recognizing the possibility of underlying kidney rupture in a patient with generalized peritonitis. UPJO might be the possible cause of pyonephrosis in our case. Regarding its treatment, nephrectomy is a preferable option when the affected kidney is not fully functional and the contralateral kidney is normal.

National Center for Biotechnology Information , U. Int Med Case Rep J. Published online May Desalegn Markos Shifti 1 and Kebebe Bekele 2. Desalegn Markos Shifti 1 St. Author information Copyright and License information Disclaimer. Correspondence: Desalegn Markos Shifti, St. This work is published and licensed by Dove Medical Press Limited. By accessing the work you hereby accept the Terms.

Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. This article has been cited by other articles in PMC. Abstract Background Peritoneal fistulization of a pyonephrosis is an extremely rare event which invariably leads to generalized peritonitis.

Case presentation A year-old male patient from the rural part of Bale zone, Ethiopia, was admitted to Goba Referral Hospital with high-grade fever, diffused abdominal pain and abdominal distension. Conclusion This case report highlighted the importance of recognizing the possibility of underlying kidney rupture in a patient with generalized peritonitis.

Keywords: pyonephrosis, generalized peritonitis, abscess, perforation, nephrectomy, case report. Introduction The accumulation of purulent exudate in the hydronephrotic collecting system and abscess formation constitute the pathophysiology of pyonephrosis.

Open in a separate window. Figure 1. Macroscopic view of the left kidney after nephrectomy was performed. Consent Written informed consent was obtained from the patient for publication of this case report. Conclusion This case report highlights the importance of recognizing the possibility of underlying kidney rupture in a patient with generalized peritonitis.

Footnotes Disclosure The authors report no conflicts of interest in this work. References 1. Akut Pyelonefrit ve pyonefroz. A giant case of pyonephrosis resulting from nephrolithiasis.

Case Rep Urol. Peritonitis after spontaneous rupture of pyonephrotic kidney into a peritoneal cavity. Am J Surg. Kidney Dial. Pyonephrosis: diagnosis and treatment.

GIENAPP CIVIL WAR AND RECONSTRUCTION PDF

Akut pyelonefritis

.

C33725 DATASHEET PDF

Pyelonefritis

.

Related Articles