Female patient, 62 years old, poorly controlled diabetic, obese, with a history of left unresolved coralline lithiasis.
She presented with fever and left low back pain of 7 days of evolution, with oral mycosis and marked deterioration of her general condition.
He has leukocytosis with marked neutrophilia, hyperglycemia with ketoacidosis and high levels of urea and creatinine.
On physical examination, the abdomen was blunt, with pain in the left flank and a positive left renal percussion.
Abdominal ultrasound and direct abdominal X-ray were performed, which guided the diagnosis by identifying air in the left renal fossa.
Abdominal-pelvic CT scan showed air in the left kidney and perirenal tissues surrounding the abdominal wall.
Due to the rapid deterioration of his general condition, drainage of the renal fossa is performed by lumbotomy to prevent contamination of the peritoneal cavity, evacuating the gas and debridement of necrotic tissue.
After initial improvement, signs of sepsis reappeared, requiring a simple nephrectomy one week later.
Good postoperative evolution, at 14 days new sepsis of respiratory origin.
It begins with purulent secretion through the wound, is performed "toilette", but dies at 48 hours due to multiple organ dysfunction with nosocomial pneumonia.
