Journal of Clinical Nephrology and Therapeutics publishes the manuscripts that are directly or indirectly based on variegated aspects of clinical nephrology, diabetic nephropathy, pediatric nephrology, renal physiology, renal histopathology, immunobiology, intensive care nephrology, and ischemic nephropathy.

Treatment of obstructive uropathy is a common urological referral. The two treatment options are nephrostomy tube or ureteric stent insertion. Both are equally effective at providing collecting system drainage and as both have different specific advantages and disadvantages, choice is often made on a case-by-case basis. Percutaneous nephrostomy has the advantages of bypassing the level of ureteric obstruction and not requiring a general anaesthetic, which can sometimes lead to deterioration in an already acutely unwell patient. The procedure can be technically difficult in overweight patients, and those without hydronephrosis, and is not without risk of significant haemorrhage. Retrograde uretericstent insertion has a lower rate of significant bleeding than percutaneous nephrostomy insertion; however, it is sometimes not possible to gain access to the kidney, such as in cases of large impacted stones or abnormal urinary tract anatomy due to pelvic disease. Here, we present a case with a rare cause of bilateral ureteric obstruction secondary to an iatrogenic pelvic haematoma.

A fifty-four-year-old male, with a metallic aortic valve on warfarin, presented with acute appendicitis. He underwent laparoscopic appendicectomy which revealed a necrotic appendix. Initial post-operative recovery was uneventful and he was discharged seven days following admission. He re-presented three days after discharge with hypovolaemic shock and abdominal distension. CT abdomen/ pelvis showed rectus sheath haematoma with significant abdominal and pelvic extension. His warfarin was reversed and a bleeding inferior epigastric artery was controlled by embolisation by interventional radiology

This case reinforces that fact that lack of hydronephrosis does not exclude ureteric obstruction. As this patient was hypovolaemic on admission, it was thought that this was the reason for his renal impairment. As it transpired, this was not the sole cause, and while it contributed to renal impairment, it also resulted in acute tubular necrosis which masked his obstructive uropathy. While the initial plan for the management of his renal impairment had been bilateral retrograde ureteric stenting, anatomical distortion rendered this impossible and he was subsequently treated with a unilateral retrograde ureteric stent and contralateral percutaneous nephrostomy.

Best Regards,
Anna Melissa
Editorial Manager
Journal of Clinical Nephrology and Therapeutics