Abstract

Flank pain, abdominal pain and hematuria are common complaints in emergency medicine. We describe the case of a 72-year-old female who presented to the emergency department for worsening left lower quadrant abdominal pain and left flank pain associated with new-onset hematuria. The patient reported that the pain began immediately after she accidently tripped on a rock which resulted in a forceful twist of her body and catching herself with her hands without any direct impact to her body. A delayed contrast enhanced CT showed evidence of left kidney rupture with leakage of the contrast dye through the left renal calyx into the lower part of the abdomen and musculature. Flank/abdominal pain with or without hematuria are common ED complaints. In this case, the combination of a good history and physical examination in conjunction with delayed CT imaging ultimately led to the correct diagnosis of a kidney rupture. It is important to note that immediate and delayed contrast enhanced CT remains the gold standard in diagnosis of this condition. The treatment of kidney rupture is dependent on the stability of the patient. Hemodynamically stable patients should be treated with conservative management, while hemodynamically unstable patients should be treated with either angioembolization by interventional radiology or with stenting or nephrectomy by surgery.