Retroperitoneal glass foreign body with renal parenchymal involvement after 25 years of silent retention: a case report.

We report a 46-year-old woman in whom a glass foreign body retained in the retroperitoneum for 25 years caused recurrent exertional gross haematuria after apparent migration through the quadratus lumborum muscle into the upper renal pole and calyceal system. A penetrating thoracolumbar injury sustained in a motor vehicle accident 25 years earlier had gone untreated. Initial evaluation at an outside institution attributed the symptoms to nephrolithiasis for over 12 months. Multiphase contrast-enhanced CT demonstrated two hyperdense foreign-body fragments (∼1,150-1,200 HU) along a single track extending from the right L5 transverse process through the quadratus lumborum into the renal parenchyma, consistent with a fractured retained glass foreign body. Volumetric 3D CT reconstruction delineated the fragment trajectory in three planes and was consistent with the absence of major vascular encasement. Flexible ureterorenoscopy visualised glass within the renal pelvis, and endoscopic-only retrieval was considered unfeasible. Laparoscopic transperitoneal removal was performed: after medial mobilisation of the ascending colon and incision of Gerota's fascia, both fragments were dissected free under magnified direct vision and removed completely-a proximal fragment (∼3 cm) from the quadratus lumborum and a distal fragment (∼4 cm) from the renal parenchyma. No vascular or parenchymal injury occurred; the patient was discharged after an uneventful 7-day postoperative stay. To our knowledge, and based on the available published literature, no prior case describes a retroperitoneal glass foreign body with renal parenchymal involvement after a comparable 25-year retention interval. This case highlights three practical lessons: a systematic trauma history is valuable in unexplained haematuria; multiphase CT with 3D reconstruction can provide both diagnosis and a surgical roadmap; and laparoscopic transperitoneal removal was safe and effective in this patient once vascular involvement had been excluded preoperatively.