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PERINEPHRIC ABSCESS ASSOCIATED WITH URETERAL FOREIGN BODY
00225347/98n594-1293.OWO
Vol. 159, 1294, April 1998 Printed in U S A
TEE JOURNAL OF UROtoCv
Copyright 0 1998 by AldEmcm UROLOGICAL ASS~CIATION, hc.
PERINEPHRIC ABSCESS ASSOCIATED WITH URETERAL FOREIGN BODY YOSHIYUKI KOJIMA, HIDEKAZU ASAKA, YUTAKA ANDO, YUTARO HAYASHI, SHOICHI SASAKI AM) KENJIRO KOHRI From the Department of Urology, Nagoya City Higashi General Hospital and Nagoya City University Medical School, Nagoya,Japan Kcr WORDS: foreign bodies, ureter, abscess
Ureteral foreign bodies are quite rare. We report an unusual case of a self-introduced foreign body in the right ureter with subsequent perinephric abscess formation. CASE REPORT
A 30-year-old man was hospitalized for anorexia, pyrexia and vague right upper quadrant abdominal pain 1month in duration. The patient reported that at the age of 15 years he had inserted a ballpoint pen refill into the urethra, which could not be removed and had remained in the patient since that time. Recurrent urinary tract infections developed, which failed to respond to conventional antibiotic therapy. Physical examination was significant for right upper quadrant tenderness. Laboratory evaluation revealed a white blood count of 14,100/mm.3 and serum C-reactive protein of 22.7 mgJdl. (normal less than 0.3). Urinalysis was significant
FIG.2. Cal&ed ballpoint pen refill after removal h o r n right ureter for pyuria, and an excretory urogram demonstrated poor visualization of the right kidney. A calcified ballpoint pen refill was seen in the pelvic cavity. Abdominal computerized tomography was suggestive of a large perinephric abscess, right hydronephrosis and a calcified foreign body within the right ureter (fig. 1,A). No portion of the pen refill was visible on cystoscopy. A percutaneous nephrostomy tube was inserted into the right kidney to relieve the outflow obstruction. Antegrade pyelogram confirmed a foreign body located along the right ureteral wall (fig. 1,B ) . A total of 500 ml. milky exudate were obtained by percutaneous drainage of the perinephric abscess. Culture of this fluid yielded Klebsiella oxytoca. Two weeks after insertion of the nephrostomy tube open ureterotomy was performed, and the calcified ballpoint pen refill was removed from the lumen of the right ureter (fig. 2). The stone-like material that had formed around the ballpoint pen refill was composed of calcium phosphate and calcium carbonate. Renal function and right hydronephrosis improved as demonstrated on a postoperative excretory urogram. Convalescence was uneventful.
Accepted for publication September 19, 1997.
DISCUSSION
Self-introducedforeign bodies are found most frequently in the urethra and bladder.' However, ureteral foreign bodies introduced through the urethra are extremely rare. Toothpick, cat hair, hair pin and a blade of grass have been reported to have been introduced through the urethra, subsequently traveling through the bladder into the ureter.' In our case the foreign body was a ballpoint pen refill, which had been inserted into the urethra 15 years earlier. We believe that the foreign body gradually migrated in a retrograde direction to the ureter. The perinephric abscess resulted from the recurrent pyelonephritis. This is the first case that we have encountered in which a ureteral foreign body of this type was associated with subsequent perinephric abscess formation. REFERENCES
Rc. 1. A,abdominal com uterized tomography shows large perinephric abscess. B , antegrafe pyelogram reveals ballpoint pen refill located within right ureter (arrows). 1294
1. W o r d , S.D.,Persad, R A, Bmster, S. F. and Gingell, J. C.: Intravesical foreign bodies: five-year rwiew. Brit. J. Uml., 69:41,1992. 2. Campbell, E.W.: Foreign bodies in the urinary tract. In: Urology. Edited by M. F. Campbell. Philadelphia:W. B. Saunders, Co., vol. 1, chapt. 17, pp. 775-795, 1963.
Vol. 159, 1294, April 1998 Printed in U S A
TEE JOURNAL OF UROtoCv
Copyright 0 1998 by AldEmcm UROLOGICAL ASS~CIATION, hc.
PERINEPHRIC ABSCESS ASSOCIATED WITH URETERAL FOREIGN BODY YOSHIYUKI KOJIMA, HIDEKAZU ASAKA, YUTAKA ANDO, YUTARO HAYASHI, SHOICHI SASAKI AM) KENJIRO KOHRI From the Department of Urology, Nagoya City Higashi General Hospital and Nagoya City University Medical School, Nagoya,Japan Kcr WORDS: foreign bodies, ureter, abscess
Ureteral foreign bodies are quite rare. We report an unusual case of a self-introduced foreign body in the right ureter with subsequent perinephric abscess formation. CASE REPORT
A 30-year-old man was hospitalized for anorexia, pyrexia and vague right upper quadrant abdominal pain 1month in duration. The patient reported that at the age of 15 years he had inserted a ballpoint pen refill into the urethra, which could not be removed and had remained in the patient since that time. Recurrent urinary tract infections developed, which failed to respond to conventional antibiotic therapy. Physical examination was significant for right upper quadrant tenderness. Laboratory evaluation revealed a white blood count of 14,100/mm.3 and serum C-reactive protein of 22.7 mgJdl. (normal less than 0.3). Urinalysis was significant
FIG.2. Cal&ed ballpoint pen refill after removal h o r n right ureter for pyuria, and an excretory urogram demonstrated poor visualization of the right kidney. A calcified ballpoint pen refill was seen in the pelvic cavity. Abdominal computerized tomography was suggestive of a large perinephric abscess, right hydronephrosis and a calcified foreign body within the right ureter (fig. 1,A). No portion of the pen refill was visible on cystoscopy. A percutaneous nephrostomy tube was inserted into the right kidney to relieve the outflow obstruction. Antegrade pyelogram confirmed a foreign body located along the right ureteral wall (fig. 1,B ) . A total of 500 ml. milky exudate were obtained by percutaneous drainage of the perinephric abscess. Culture of this fluid yielded Klebsiella oxytoca. Two weeks after insertion of the nephrostomy tube open ureterotomy was performed, and the calcified ballpoint pen refill was removed from the lumen of the right ureter (fig. 2). The stone-like material that had formed around the ballpoint pen refill was composed of calcium phosphate and calcium carbonate. Renal function and right hydronephrosis improved as demonstrated on a postoperative excretory urogram. Convalescence was uneventful.
Accepted for publication September 19, 1997.
DISCUSSION
Self-introducedforeign bodies are found most frequently in the urethra and bladder.' However, ureteral foreign bodies introduced through the urethra are extremely rare. Toothpick, cat hair, hair pin and a blade of grass have been reported to have been introduced through the urethra, subsequently traveling through the bladder into the ureter.' In our case the foreign body was a ballpoint pen refill, which had been inserted into the urethra 15 years earlier. We believe that the foreign body gradually migrated in a retrograde direction to the ureter. The perinephric abscess resulted from the recurrent pyelonephritis. This is the first case that we have encountered in which a ureteral foreign body of this type was associated with subsequent perinephric abscess formation. REFERENCES
Rc. 1. A,abdominal com uterized tomography shows large perinephric abscess. B , antegrafe pyelogram reveals ballpoint pen refill located within right ureter (arrows). 1294
1. W o r d , S.D.,Persad, R A, Bmster, S. F. and Gingell, J. C.: Intravesical foreign bodies: five-year rwiew. Brit. J. Uml., 69:41,1992. 2. Campbell, E.W.: Foreign bodies in the urinary tract. In: Urology. Edited by M. F. Campbell. Philadelphia:W. B. Saunders, Co., vol. 1, chapt. 17, pp. 775-795, 1963.