Hindawi Publishing Corporation Case Reports in Urology Volume 2013, Article ID 932529, 3 pages http://dx.doi.org/10.1155/2013/932529 Case Report Spontaneous Renal Pelvis Rupture: Unexpected Complication of Urolithiasis Expected to Passage with Observation Therapy Tuncay Tas, 1 Basri CakJroglu, 2 and Süleyman Hilmi Aksoy 3 1 Department of Urology, Star Medica Hospital, Orta Cami Mah. Cengiz Topel Meydanı No. 10, 5900 Tekirdag, Turkey 2 Department of Urology, Hisar Intercontinental Hospital, Saray Mahallesi Site Yolu Caddesi No. 7, Umraniye, 34768 Istanbul, Turkey 3 Department of Radiology, Hisar Intercontinental Hospital, Saray Mahallesi Site Yolu Caddesi No. 7, Umraniye, 34768 Istanbul, Turkey Correspondence should be addressed to Basri Cakıroglu; drbasri@gmail.com Received 20 June 2013; Accepted 29 August 2013 Academic Editors: M. Gallucci and L. Henningsohn Copyright © 2013 Tuncay Tas et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Seventy percent of ureteral stones are located at distal ureter. Efective and safe passage of distal ureter stones is mediated by observation or medical expulsive treatment. Most of stones located at distal ureter pass spontaneously under observation; however, some are complicated with urinary tract infection, hydronephrosis, and renal function disturbances. Spontaneous perforation of the upper ureter is a rare condition that poses diagnostic and therapeutic problems. his case is reported, because the patient developed an unexpected spontaneous renal pelvis rupture (SRPR), while she was under observation and expected to pass her right ureteral stone spontaneously through hydration and analgesic treatment. 1. Introduction Ureteral stones are 20% of urinary tract stones. Seventy percent of ureteral stones are located at distal ureter. Efective and safe passage of distal ureter stones is mediated by observation or medical expulsive treatment [1]. Most of stones located at distal ureter pass spontaneously under observation; however, some are complicated with urinary tract infection, hydronephrosis, and renal function distur- bances. Urine extravasation from the renal collecting system or renal pelvis is a rare condition. When urine extravasation happens, it is generally related to obstruction, trauma, or previous urinary tract surgery [2]. his case is reported, because the patient developed an unexpected spontaneous renal pelvis rupture (SRPR), while she was under observation and expected to pass her right ureteral stone spontaneously through hydration and analgesic treatment. 2. Case Report A 52-year-old woman has been admitted to the emergency department with acute lank pain for the last 6 days. Four days ago, the patient was followed in another clinic with observation option for spontaneous passage of distal ureteral stone. Hydration and twice daily diclofenac sodium 50 mg orally were recommended to the patient. he patient has been admitted to our emergency urology clinic with increased pain in the last 8 hours, increased nausea, and vomiting; no pathology was present in her medical history. Physical examination revealed difuse pain in the right abdomen with tenderness. Tenderness in costovertebral angle with local coolness in skin was present. In urinary ultra- sonography, hydronephrosis and abundant luid collection in perinephric area were seen. he let kidney was nor- mal. In abdominal computerised tomography, rupture of renal pelvis in two points, peripheral luid accumulation, contrast extravasation, and a 6 mm stone in right distal ureter were seen (Figures 1 and 2). In serum biochemical analysis hemoglobin level was 11.2 g/dL. Serum creatinine, urea, and other values were within the normal limits. Ater pain control, ureteroscopic lithotripsy, D-J stent replacement under scopy, and drain placement to perinephritic renal place were performed. Double-J ureteral stent was inserted under luoroscopy, percutaneous drainage of the urinoma