[Rare severe complications of pediatric nephrolithiasis in high-altitude areas: a case of paralytic ileus secondary to renal abscess rupture].

Urinary tract stones complicated by infection are relatively common, whereas renal abscess rupture complicated by paralytic ileus is extremely rare. On March 1, 2025, a 22-month-old boy was admitted to the Department of Pediatrics, Lhasa People's Hospital. He presented with secondary paralytic ileus resulting from renal abscess rupture secondary to nephrolithiasis. The patient was hospitalized with a 10-day history of cough, expectoration, abdominal pain and distension. Given severe abdominal distension and intestinal obstruction, emergency small bowel decompression and abdominal abscess drainage were performed under general anesthesia. Postoperatively, the patient developed a large volume of pale yellow clear abdominal drainage, polyuria, and unexplained persistent hyperkalemia and hyponatremia. Creatinine detection of the abdominal drainage fluid and contrast-enhanced abdominal CT confirmed renal rupture. The final diagnoses included left nephrolithiasis complicated with hydronephrosis and infection, left renal abscess, left perirenal abscess, left renal rupture, right nephrolithiasis, diffuse peritonitis, paralytic ileus, sepsis, and adenoviral pneumonia. Following comprehensive management including combined antimicrobial therapy (meropenem, vancomycin and fluconazole), local drainage (perirenal puncture drainage and ureteral stenting), parenteral nutrition, and electrolyte correction, the patient's symptoms resolved and all laboratory indicators returned to normal. The patient was discharged after 44 days of hospitalization and had an uneventful 2-month follow-up. Clinical manifestations of renal abscess in children are non-specific, and the condition is prone to being missed or misdiagnosed. In children with intestinal obstruction of unknown common etiology, clinicians should stay alert to complications associated with urinary tract infection and promptly arrange contrast-enhanced abdominal CT and other examinations for etiological clarification. Early combined antimicrobial therapy and local drainage are critical to improving the therapeutic success rate. In addition, pediatric urinary tract calculi have a high incidence in high-altitude areas. Therefore, targeted health education for local residents should be strengthened to raise awareness of early medical intervention.