A Presumed Acquired Ureteral Diverticulum Presenting With Hematuria, Urosepsis, and Periureteral Contrast Leak: A Rare Case Report.

Ureteral diverticulum is an exceptionally rare abnormality that may be congenital or acquired secondary to chronic obstruction, calculi, infection, or prior instrumentation. While often asymptomatic, complicated cases can present with hematuria, recurrent UTIs, or sepsis. A 60-year-old bedridden woman with morbid obesity and a history of multiple endourological procedures presented with urosepsis and hematuria. Computed tomography demonstrated mild hydroureteronephrosis and a periureteric fluid collection with gas locules and contrast extravasation, initially raising suspicion of an infected urinoma. Subsequent retrograde pyelography and rigid ureteroscopy confirmed a narrow-necked ureteral diverticulum at the level of the sacroiliac joint. Following antibiotic therapy and urinary drainage, the patient improved clinically and was managed conservatively due to her high operative risk, remaining asymptomatic at follow-up. Acquired ureteral diverticulum should be considered in patients with hematuria, urosepsis, and a history of prior endourological procedures when cross-sectional imaging shows periureteric collections or contrast leakage. Retrograde pyelography and ureteroscopy are essential for distinguishing a diverticulum from free ureteral perforation. Conservative management with urinary drainage is a viable approach in selected high-risk patients.