A kidney stone that caused bowel obstruction

Nephrolithiasis is common and increasingly prevalent in the United States. It usually presents with flank pain and hematuria, but sequelae such as hydroureteronephrosis, forniceal rupture and pyelonephritis can escalate the clinical picture. Rarely, a massively dilated collecting system exerts enough mass effect on adjacent structures to obstruct the bowel.

A 43-year-old woman presented with left upper quadrant pain, fever, nausea and vomiting. Imaging revealed a 0.7 cm obstructive stone at the right ureterovesical junction with severe hydroureteronephrosis causing mass effect on the duodenum and upstream gastric dilation. Placement of a percutaneous nephrostomy resolved both the hydroureteronephrosis and the secondary gastrointestinal obstruction.

Four weeks later, the patient returned for ureteroscopy and laser lithotripsy, but the stone was no longer visualized and post-operative imaging confirmed it had passed spontaneously. Retrograde pyelogram showed severe J-hooking of the proximal ureter that could not be traversed with a guidewire, so no ureteral stent was placed and the nephrostomy was left to drain. Three weeks later the tube was capped; after a successful capping trial, it was removed two weeks later. The case highlights a rare complication of nephrolithiasis and underscores the value of timely, measured urinary diversion in preventing clinical decompensation.

The work titled “Gastrointestinal obstruction secondary to chronic obstructive nephrolithiasis: A case report” was published in UroPrecision (published on April 1, 2026).