A Highly Uncommon Variation of Spontaneous Urinary Extravasation as an Unusual Presentation of Distal Ureteric Calculus

Urolithiasis is a leading cause of acute abdominal pain and one of the most common conditions seen in emergency departments worldwide. Spontaneous Urinary Extravasation (SUE) is a relatively uncommon manifestation of distal ureteric urolithiasis and has a wide spectrum of clinical presentations depending on the site of urine leakage. Perforation could occur at any level from the calix to the bladder but it is usually seen at the fornices or upper ureter. It is important to distinguish true rupture of the ureter from the forniceal tear with backflow extravasation because clinical presentations, outcomes and treatments are different. In this case study, a 29-year-old man was admitted to our hospital with sudden-onset of left fossa iliaca pain, fever and lower urinary tract symptoms after a short pain-free period following spontaneous cessation of an acute renal colic. He also had a microscopic haematuria and pyuria on his urinalysis. Contrast Enhanced Computed Tomography of the abdomen (CECT) showed an impacted tiny calculus (< 5mm) in the left intramural ureter and a urine extravasation from both the calyceal fornix and the upper ureter. This unique case is a highly uncommon variant of stone-induced SUE because of a special association between these two phenomena, raising both diagnostic and management challenges.