Mirroring Mystery: Bilateral Spontaneous Perinephric Urinoma Unveiled

Background: Urinomas are accumulations of urine located in the retroperitoneal area, most frequently in the perirenal space. These collections typically result from leakage within the urinary tract, often due to obstruction, trauma, or post-procedural instrumentation. Bilateral spontaneous urinomas without an underlying cause are extremely uncommon.

Case Presentation: An 18-year-old male presented with left flank pain and episodes of vomiting but without any history of trauma, surgery, or significant comorbidities. Clinical examination was unremarkable, and laboratory investigations, including urine analysis and culture, were normal. Ultrasonography of the abdomen revealed bilateral heterogeneous subcapsular collections, which were further characterized on contrast-enhanced computed tomography (CT) as mild-to-moderate subcapsular fluid collections with debris and hemorrhagic foci. Fluid analysis from the aspirated collections showed normal findings, with no evidence of infection. A diagnosis of bilateral spontaneous perinephric urinoma was established, and the patient was successfully managed conservatively.

Discussion: This case highlights the rarity of bilateral spontaneous perinephric urinomas in patients without typical risk factors, emphasizing the diagnostic value of imaging in such unusual presentations. Conservative management was effective in resolving the urinomas, supporting a non-invasive approach in cases without infection or obstruction. This report contributes to the limited knowledge on spontaneous urinomas and underscores the importance of individualized treatment planning.

Conclusion: This case underscores the importance of imaging in diagnosing rare presentations of perinephric urinoma, especially in patients without obvious risk factors. It highlights that conservative management can be effective in cases without infection or obstruction, offering a safe alternative to surgical intervention.