Gross hydronephrosis secondary to pelviureteric junction structure, complicated with caliceal rupture

A 23-year-old Myanmar male with previous history of percutaneous nephrolithotomy was presented with acute abdominal pain for 2 days. The pain was pricking in nature and started at left lumbar region and later became generalized. There was no fever, vomiting or history of trauma. The bowel and urinary output were normal. On examination, he was alert and mildly dehydrated. The vital signs were stable. Per abdomen revealed generalized guarding and tender mostly over the left lumbar region. Abdomen radiograph showed left abdominal homogenous opacity with bowel displacement to the right. A round calculus was appreciated at the left lumbar region (Figure 1a). Urgent contrast enhanced CT abdomen revealed gross hydronephrosis with stricture at the left pelviureteric junction (Figure 1b). There was caliceal wall defect at the upper pole calyx (Figure 2a) with perirenal free fluid (Figure 2b). Patient underwent urgent ultrasound-guided left nephrostomy insertion and was discharged well.