Nebiyu Shitaye
Perinephric urinoma is an encapsulated collection of urine resulting from urine extravasations into the perirenal space either through rupture of a calyceal fornix or a tear in the renal parenchyma. Respiratory distress as a result of urinoma is an extremely rare condition in neonates and infants. A 21-day-old male neonate who presented with tense abdominal distension, respiratory distress, cyanotic spells, vomiting, and inconsolable crying. Abdominal ultrasonography demonstrated bilateral hydronephrosis and a massive left perinephric fluid collection. CT urography revealed a giant left perinephric urinoma communicating with the left renal collecting system, causing significant mass effect and displacement of abdominal organs. Voiding cystourethrography confirmed posterior urethral valves with bilateral vesicoureteral reflux. Emergency open drainage of the urinoma and Blocksom vesicostomy were performed, resulting in prompt clinical improvement. Definitive valve ablation was subsequently undertaken at 1 year of age. At 2-year follow-up, the child remained clinically stable with preserved renal function and no evidence of chronic kidney disease. Although rare, perinephric urinoma secondary to calyceal fornix rupture should be considered in the differential diagnosis of neonatal respiratory distress associated with abdominal distension. Prompt investigation and intervention are essential to optimize outcomes.