Spontaneous Perinephric Hematoma in Patients of Pyelonephritis: Case Series of an Uncommon Complication

Introduction: Spontaneous Perinephric Hematoma (SPH) used to remain undiagnosed because of deep-seated location of kidney protected by multiple anatomical envelopes. This is no more the case after easy availability of ultrasound and CT scan; and now, SPH is being diagnosed more often. SPH can occur due to various causes like inflammatory, infective, vascular conditions and bleeding diathesis. SPH can occur in association with pyelonephritis, whether non-obstructive or due to ureteric obstruction. There is no established protocol for management of SPH associated with pyelonephritis. In an attempt to fill up this vacuum, we evaluated our cases of SPH which occurred in patients admitted for indoor treatment of non-obstructive pyelonephritis with the aim was to arrive at appropriate management protocol of SPH associated with pyelonephritis. Methods: A review of record files of 82 cases of non-obstructive pyelonephritis admitted in department of urology of Goa Medical College, GOA, India from January, 2020 to April, 2024 was done. SPH was detected in 5 cases, and as per our protocol, in all 5 cases, SPH was treated by minimally invasive approach in the form of Single Stage Aspiration (SSA) +/- Pigtail catheter placement. Out of 5 cases, 2 patients were cured with SSA alone; 1 patient required an additional procedure in the form of 2nd stage Pigtail placement due to recurrence of hematoma after SSA; and 2 cases were treated with SSA + Pigtail done in same sitting. No emergency exploration of SPH was done in any case and renal salvage could be achieved in all 5 cases. Conclusion: SSA +/-Pigtail Catheter as primary therapeutic modality was found to be safe and effective for treatment of SPH in Pyelonephritis though the number of cases in this study was small.