Ureteral stones are the most common causes of spontaneous ur

Ureteral stones are the most common causes of spontaneous ureteral rupture. Most patients received ureteroscopy and double-J stenting. Conservative management with (-)-p-Bromotetramisole Oxalate can also have a favorable outcome. Most patients experience a sudden onset of abdominal or flank pain. Spontaneous ureteral rupture should be considered as a possible differential diagnosis when a patient presents with flank pain at an emergency department.
Introduction
Case Report A 34-year-old male presented with complex partial seizure. Brain computed tomography (CT), CT angiography (CTA) (Figure 1) and magnetic resonance imaging revealed a 2.3 cm × 1.4 cm hematoma with multiple surrounding engorged vessels in the left parietal region. Subsequent digital subtraction angiography (DSA, Figure 2) confirmed a Cognard type III DAVF. The DAVF was embolized with Onyx from the left occipital artery through the external carotid artery. Angiography after transarterial embolization (TAE) revealed complete obliteration of the lesion and no occlusion of any other arterial or venous structures. Headache and confusion developed 6 hours after embolization and repeat brain CT (Figure 3C) showed progressive left parietal hematoma with marked perifocal edema and adjacent congested vein. Osmotic agent therapy with mannitol improved his symptoms. Nine days after endovascular therapy, acute onset of right hemiplegia developed. Brain CT (Figure 3D) findings were consistent with left frontal-parietal infarction and brain herniation. DSA (Figures 3E and 3F) confirmed left transverse sinus to sigmoid sinus thrombosis. Revascularization with endovascular angioplasty and thrombolysis were attempted but failed. Emergent left decompressive craniectomy and hematoma evacuation were performed. The patient continued to have right upper-limb weakness after the operation. His disseminated intravascular coagulation profile was checked on the first day after surgery. Fibrinogen, D-dimer, and fibrin degradation product levels were elevated; protein S and antithrombin were reduced, whereas platelet count, global clotting times (i.e., activated partial thromboplastin time and prothrombin time), and protein C were within normal range. Only the protein S was persistently low; the other test results were unremarkable on repeated laboratory studies 2 weeks after surgery.
Discussion The vein of Labbé and sigmoid sinus of the patient were patent before and immediately post-TAE of the DAVF. Consciousness disturbance after the endovascular therapy with new hematoma could be explained by the compromise of the cortical draining vein because of previous hematoma enlargement with perifocal edema. Although osmotherapy improved the initial post-TAE brain edema in our patient, it simultaneously created dehydration status and potentiated the development of silent CVT over 9 days post-TAE. Other than dehydration status, our patient also had risk factors for CVT such as coagulation disorders and hematological conditions. Protein S deficiency was noted on the follow-up laboratory test. Redistribution of the venous drainage pathways and subsequent venous hypertension were suggested as causing the pathophysiological change. However, extensive collateral circulation within the cerebral venous system enables a considerable degree of compensation in the early stages of venous occlusion. This insidious process of CVT could lead clinicians to delay diagnosis. In addition, patients with CVT always present with syndromes clinically indistinguishable from isolated headache and intracranial hypertension.
Conclusions
Introduction Laparoscopic nephrectomy (LN) was first performed by Clayman et al in 1991 for a benign kidney disease. Since then, the laparoscopic technique has rapidly evolved and has been used for renal malignancies and live kidney donation. More extensive and complicated laparoscopic renal surgical procedures have been increasingly performed at several urological centers worldwide. The advantages of laparoscopy over open renal surgery have been clearly documented including reduced postoperative pain, shortened hospital stay, more rapid return to normal activities, and improved cosmoses. In the field of urology, LN, including simple nephrectomy, radical nephrectomy, donor nephrectomy, nephroureterectomy, and partial nephrectomy, has become the most frequently performed laparoscopic procedure. However, laparoscopic renal surgery is associated with unique challenges and complications compared with open renal surgery. Such complications are increasingly uncommon because of increasing experience; for instance, bowel-related complications are < 1% and predominantly ileus related.