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Ureteral rupture with retroperitoneal urinoma caused by peritoneal metastases of gastric cancer

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Abstract

We describe the rare case of a patient with ureteric rupture during systemic drug treatment for peritoneal metastases of gastric cancer, who underwent double-J stent placement. A 66-year-old man with gastric cancer was referred to the authors’ hospital. Esophagogastroduodenoscopy showed an irregular elevated lesion with thickened gastric folds, and biopsy specimens revealed a poorly differentiated adenocarcinoma. Abdominal contrast-enhanced computed tomography (CT) revealed extensive wall thickening with homogeneous enhancement of the stomach, enlarged lymph nodes in the perigastric area, and nodules in the peritoneal cavity, suggesting peritoneal metastases. The clinical diagnosis was cT4N2M1 with peritoneal metastases, and the patient received chemotherapy (S-1 plus oxaliplatin). After six courses of chemotherapy, the patient presented to the emergency outpatient department with a complaint of acute severe pain in the left lower back. Emergency abdominal contrast-enhanced CT showed extravasation of the contrast medium from the left upper ureter in the periureter area along with the retroperitoneum, and there was no mass lesion or stone in the kidney, ureter, or bladder. A double-J stent was placed under cystoscopic guidance, and no resistance was felt when the stent was inserted. The patient’s postprocedural course was uneventful, and he received ramucirumab in combination with paclitaxel after double-J stent placement. However, 2 months later, systemic drug treatment was discontinued because of loss of appetite and increased general fatigue and changed to the best supportive care. His general condition gradually deteriorated, and he died 3 months after the ureteral rupture. Prompt interventions, including retrograde placement of ureteral stents with concurrent use of antibiotics, will reduce mortality and morbidity in this rare entity.

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Data availability

The data include individual patient data, but the data are available from the corresponding authors upon reasonable request.

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Acknowledgements

We would like to acknowledge the contributions of our colleagues from the Department of Surgery, Kochi Medical School.

Funding

This case report was not supported by any funding.

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Authors and Affiliations

  1. Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan

    Tsutomu Namikawa, Keiichiro Yokota, Masaya Munekage, Sunao Uemura, Hiromichi Maeda & Hiroyuki Kitagawa

  2. Department of Anesthesiology, Hata Prefectural Hospital, Kochi, Japan

    Takahiko Tamura

  3. Department of Urology, Kochi Medical School Hospital, Kochi, Japan

    Takashi Karashima & Keiji Inoue

  4. Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan

    Michiya Kobayashi

  5. Integrated Center for Advanced Medical Technologies, Kochi Medical School Hospital, Nankoku, Kochi, Japan

    Kazuhiro Hanazaki

Authors
  1. Tsutomu Namikawa
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  2. Keiichiro Yokota
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  3. Masaya Munekage
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  4. Sunao Uemura
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  5. Hiromichi Maeda
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  7. Takahiko Tamura
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  8. Takashi Karashima
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  9. Keiji Inoue
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  10. Michiya Kobayashi
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  11. Kazuhiro Hanazaki
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Contributions

All listed authors contributed to the original manuscript. TN and MK: designed the study. TN, KY, MM, SU, HM, HK, TT, TK, KI and KH: have been involved in drafting the manuscript and revising it critically for important intellectual content. TN and KH: finalized the manuscript and submitted the paper for publication. All authors have read and approved the manuscript of this case report.

Corresponding author

Correspondence to Tsutomu Namikawa.

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All authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee. For this type of study, formal consent is not required.

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Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

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Namikawa, T., Yokota, K., Munekage, M. et al. Ureteral rupture with retroperitoneal urinoma caused by peritoneal metastases of gastric cancer. Int Canc Conf J 12, 53–58 (2023). https://doi.org/10.1007/s13691-022-00578-3

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  • DOI: https://doi.org/10.1007/s13691-022-00578-3

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