Massive hydropyonephrosis on pediatric patient: A case report of management and source control.

IF 0.6 Q4 SURGERY International Journal of Surgery Case Reports Pub Date : 2025-01-01 Epub Date: 2024-12-23 DOI:10.1016/j.ijscr.2024.110766
Nadya Rahmatika, Soetojo Wirjopranoto, Yufi Aulia Azmi, Antonius Galih Pranesdha Putra, Kevin Muliawan Soetanto
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Abstract

Introduction and importance: Dilation and stretching of the collecting system of the kidney due to obstruction of urine flow is called hydronephrosis. This case may be accompanied by the presence of pus known as pyonephrosis. This case report reporting massive pyonephrosis in pediatrics related to management and source of control.

Case presentation: A 10-year-old boy came in with the main complaints of high fever, decreased appetite, vomiting, and nausea. The examination showed left severe hydronephrosis (+) with a size of 14.59 × 6.9 × 9.2 cm. The patient underwent percutaneous nephrostomy (PCN) and showed pus production. From the antegrade pyelography (APG) during PCN, it was stenosis of the left ureteropelvic junction (UPJ). Empirical antibiotics were administered, followed by albumin transfusion. Antibiotics were changed on day 3 post-PCN when urine culture results showed Staphylococcus aureus. After successful improvement of the general condition and minimal pus production from PCN, the patient had a Double J Stent (DJ) and pyeloplasty on the left UPJ. The patient was discharged on day 4 after the left pyeloplasty.

Clinical discussion: Management of UPJ Stenosis with massive hydronephrosis complications can be done in two stages with the first stage being the diversion of pus from the kidney, then followed by pyeloplasty management. Management is continued with nephrostomy or ureteral stent placement for urine diversion. Management of bacterial infections is adjusted according to culture results.

Conclusion: Management of hydronephrosis with pyonephrosis as complications can be be carried out in two stages, pus diversion, then followed by the pyeloplasty.

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小儿大量肾盂积水:1例处理及源头控制。
导言及重要性:由于尿流受阻而引起肾脏收集系统的扩张和拉伸称为肾积水。这种情况可能伴有脓,称为脓肾。本病例报告与小儿大量肾盂的处理及来源控制有关。病例介绍:一名10岁男童就诊,主诉为高热、食欲减退、呕吐和恶心。左侧严重肾积水(+),大小14.59 × 6.9 × 9.2 cm。患者接受了经皮肾造口术(PCN)并出现脓流。PCN时的顺行肾盂造影(APG)显示为左侧肾盂输尿管连接处(UPJ)狭窄。给予经验性抗生素,然后输注白蛋白。pcn后第3天,尿培养结果为金黄色葡萄球菌时,更换抗生素。在成功改善一般情况和PCN产生的脓量减少后,患者接受了双J型支架(DJ)和左侧UPJ的肾盂成形术。患者于左侧肾盂成形术后第4天出院。临床讨论:UPJ狭窄合并大量肾积水并发症的处理可分为两个阶段,第一阶段是将脓从肾脏转移,然后进行肾盂成形术处理。继续行肾造口术或输尿管支架置入术进行尿分流。根据培养结果调整细菌感染的处理。结论:肾积水合并肾盂积水的治疗可分两期进行,先引流,再行肾盂成形术。
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来源期刊
CiteScore
1.10
自引率
0.00%
发文量
1116
审稿时长
46 days
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