From the Research
A forniceal rupture is a serious condition where the fornix of the kidney tears due to increased pressure, often caused by an obstructing kidney stone, and requires prompt medical attention to prevent complications such as urinoma formation, infection, or sepsis. This condition typically occurs when there is a sudden increase in pressure within the urinary collecting system, most commonly due to an obstructing kidney stone that blocks urine flow 1. The backed-up urine creates pressure that eventually causes the fornix to tear, allowing urine to leak into the surrounding tissues. Symptoms include severe flank pain, nausea, vomiting, and sometimes fever if infection is present.
Diagnosis and Treatment
Diagnosis is usually made through CT scan with contrast, which can show both the obstruction and the urine leakage 2. Treatment primarily focuses on relieving the obstruction, typically by placing a ureteral stent or nephrostomy tube to drain the kidney. Antibiotics are necessary if infection is present. Most forniceal ruptures heal on their own once proper drainage is established.
Management Strategies
According to a recent study, conservative management is a valid option in non-complicated cases, and intervention should be reserved for complicated cases or cases with sizable urinoma 1. Another study reported a case of stone-induced ureteral rupture that failed conservative management and led to nephrectomy, highlighting the importance of prompt recognition and treatment of the condition 3.
Recent Findings
A recent case report highlighted the use of point-of-care ultrasound in diagnosing spontaneous forniceal rupture, which can aid in rapid diagnosis and prevention of complications 2. Another study reported a case of minimally invasive intervention of forniceal rupture in a solitary functioning kidney, which resulted in return of renal anatomy and facilitated early recovery 4.
Key Points
- Forniceal rupture is a urological emergency that requires prompt medical attention
- Diagnosis is usually made through CT scan with contrast
- Treatment primarily focuses on relieving the obstruction and preventing complications
- Conservative management is a valid option in non-complicated cases, while intervention is reserved for complicated cases or cases with sizable urinoma.