International journal of surgery case reports · 2025
Retained bullet in the right kidney collecting system with secondary stone formation treated with ultrasound guided PCNL in resource limited setup - Case report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
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Tegegne Chale Yohannes, Gebreamlak Abeselom Lema, Zena Alemayehu Shanko, Mekonnen Getu Andarge
Аннотация
INTRODUCTION: Foreign bodies in the kidney and renal pelvis are reported so rarely. Foreign bodies may reach the kidney by one of three routes: ascending through urethra, bladder, and ureter, from the gastrointestinal tract and by means of external violence.
CASE PRESENTATION: A 29-year-old soldier who had history of bullet injury to his right arm 3 years back presented with right flank pain, which had been progressively worsening over the past 3 months. On Physical examination there was scar and palpable deformity on the right arm. Initial imaging studies, including ultrasound shows bilateral nephrolithiasis and computed tomography (CT) scan, revealed the presence of a metallic foreign body in the right kidney collecting system, along with bilateral nephrolithiasis. The foreign body was identified as a retained metallic fragment, likely from a previous trauma. The right nephrolithiasis was attributed to stone formation around the foreign body. Given the complexity of the case, the patient was treated with ultrasound guided percutaneous nephrolithotomy (PCNL), which successfully removed both the metallic foreign body (which is found to be bullet fragment) and the renal stones. Postoperative recovery was uneventful, and the patient was discharged with no further complications.
DISCUSSION: Foreign body in the kidney is rarely reported. It has different mechanisms, external violence being the most common cause. Patient can present with unspecified flank pain, recurrent infection and secondary stone formation. The development of endourological techniques has expanded the ability to treat many intra renal disorders including removal of foreign bodies. In our case we successfully removed the renal stone and the bullet using ultrasound guided PCNL.
CONCLUSION: This case highlights the importance of considering foreign body retention and its potential to cause secondary nephrolithiasis in patients with unexplained flank pain. Early identification and appropriate intervention are crucial for optimal outcomes. Ultrasound guided PCNL is the best option of management for renal stone and retained foreign body in the collecting system in resource limited setup where fluoroscopy is not available.
CASE PRESENTATION: A 29-year-old soldier who had history of bullet injury to his right arm 3 years back presented with right flank pain, which had been progressively worsening over the past 3 months. On Physical examination there was scar and palpable deformity on the right arm. Initial imaging studies, including ultrasound shows bilateral nephrolithiasis and computed tomography (CT) scan, revealed the presence of a metallic foreign body in the right kidney collecting system, along with bilateral nephrolithiasis. The foreign body was identified as a retained metallic fragment, likely from a previous trauma. The right nephrolithiasis was attributed to stone formation around the foreign body. Given the complexity of the case, the patient was treated with ultrasound guided percutaneous nephrolithotomy (PCNL), which successfully removed both the metallic foreign body (which is found to be bullet fragment) and the renal stones. Postoperative recovery was uneventful, and the patient was discharged with no further complications.
DISCUSSION: Foreign body in the kidney is rarely reported. It has different mechanisms, external violence being the most common cause. Patient can present with unspecified flank pain, recurrent infection and secondary stone formation. The development of endourological techniques has expanded the ability to treat many intra renal disorders including removal of foreign bodies. In our case we successfully removed the renal stone and the bullet using ultrasound guided PCNL.
CONCLUSION: This case highlights the importance of considering foreign body retention and its potential to cause secondary nephrolithiasis in patients with unexplained flank pain. Early identification and appropriate intervention are crucial for optimal outcomes. Ultrasound guided PCNL is the best option of management for renal stone and retained foreign body in the collecting system in resource limited setup where fluoroscopy is not available.