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GAS CONTAINING RENAL CALCULUS : RARE !?
'Gas-containing renal stones are exceedingly rare, but have been linked to serious renal infections.'
(Urology. 2006 Oct;68(4):890.e13-5).
The first case of a gas-containing stone was reported by Simpson et al. in 1998 in a 68-year-old non-diabetic man with a history of ipsilateral untreated uretero-pelvic junction obstruction !!!
'Gas-containing urinary stones are a rare entity, and are associated with anaerobic fermenting organisms such as Escherichia coli and Klebsiella. Gas-containing renal stones are invariably associated with emphysematous pyelonephritis commonly caused by E. coli and Klebsiella. Contributing factors to gas-containing stone formation include urinary stasis, metabolic mineral derangement and, in a minority of the cases, diabetes.'
'Urinary stasis appears paramount in the formation of gas-containing urinary calculi. All patients in the literature had radiographic signs of obstruction at presentation '
In this case, even though the right kidney was slightly atrophic, there was no features of obstruction or active pyelonephritis or any gas in the PCS or perinephric region.On CT Urogram there was nephrogram at 1 minute and excretion of contrast without delay !!!.
(Manny TB, Manny JS, Hemal AK. Transmesocolic robotic extended pyelolithotomy of a large gas-containing renal stone: Case report and review of the literature. Urol Ann [serial online] 2013 [cited 2015 Apr 3];5:126-8).
DV03042015
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