RENAL STONE

1. Long case presentation
Presented by
Dr.Jafor Ekbal
Phase B Resident
Paediatric Surgery, MMCH

2. PARTICULARIS OF PATIENT:
Name :Hira Moni
Age :12 years
Sex :Female
Adress:Tarakanda,Mymensingh
Date of admission: 2 february 2023
Date of examination:14 february 2023

3. CHIEF COMPLAINTS:
1.Pain in right lumber region for 3 month
2. Right sided abdominal swelling for 3 month

4. HISTORY OF PRESENT ILLNESS:
According to the statement of the patient she
was resonabely well 3 month back.Then she
developed pain in right lumber region.which is
intermittent,colicky in nature,non
radiating,relieved by taking medication and no
aggrevating factor.She also complaints of
swelling of right lumber region ,which is
gradually increasing in size.occationally swelling
decreases after passing large volume of urine.

5. CONTINUE:
 Abdominal distention is not associated with
vomiting and alteration of bowel habit.She
voids normally with no history of passage of
cloudy urine,hematuria and fever.There is no
history of significant weight loss.With this
complaints mother took her to nearby
physician and subsiquently transferred to this
hospital.

6. ON GENERAL EXAMINATION:
Anaemia :absent
Jaundice:absent
Cyanosis:absent
Edema:absent
Temperature:98‘F
BP:100/60 mmhg
Lymph node:not palpable

7. ABDOMINAL EXAMINATION:
Abdomen is mildly distended,more marked
on right lumber region.Umbilicus is centrally
placed and inverted.No scar mark,no visible
peristalsis,no engorged vein.Liver and spleen
not palpable .There is a ballotable cystic
swelling in the right lumber region ,which
moves with respiration.

8. CONTINUE….
 Swelling is non tender,surface is
smooth,margin is ill defined and does not
cross midline.Left kidney is not
ballotable.Urinary bladder is not palpable,no
ascitis.

9. Respiratory system:Reveals normal
Cardiovascular system:Reveals normal
Nervous system:Reveals normal

10. Past history: no significant past history
Antenatal history :unevenfull
Family history:no other family member have
same type of disese.
Immunization history:immunized as per EPI
shedule.

11. SALIENT FEATURES:
Hira moni 12 years old girl presented to me with
the coplaints of right sided abdominal pain for 3
month,which is intermittent,colicky in nature,non
radiating ,no aggravating factor,relived by taking
medication.She also complaints of swelling of
right lumber region which is gradually increasing
in size.occasionally distention decreases after
passing large volume of urine.

12. CONTINUE..
She voids normally with no passage of cloudy
urine,hematuria and fever.There is no
complaints of significant weight loss.with
these complaints mother took her to nearby
physician and subsiquently transferred to this
hospital.Patient is immunized as per EPI
shedule.She is non anaemic,non icteric,and
all vital signs are normal.

13. CONTINUE….
Abdomen is distended and more prominent on
right side.Umbilicus centrally placed and
inverted,no visible perislasis or engorged vein.
Liver,Spleen not palpable.There is a ballotable
cystic swelling on right lumber region,which
moves with respiration.It is non tender ,surface
smooth,irregular mergin does not cross
midline.Left kidney not ballotable.Urinary bladder
not palpable,no ascitis. Other systemic
examination reveals normal.

14. PROVISIONAL DIAGNOSIS:
Right sided hydronephrosis

15. DIFFERENTIAL DIAGNOSIS:
 Polycystic kidney disease
 Simple cyst of kidney
 Nephroblastoma
 Neuroblastoma

16. INVESTIGATIONS:
 USG of whole
abdomen
 Plain X-ray KUB
 IVU
 Contrast CT of
abdomen
 S.creatinine
 S.electrolyte
 S.calcium
 S.PTH
 Urine R/M/E
 Urine C/S

17. USG OF WHOLE ABDOMEN:

18. IVU:

21. FINAL DIAGNOSIS:
 Bilateral renal stone with right sided
hydronephrosis