PMC3226425_01
7 mm obstructing left PUJ calculus.
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fig1
An urgent ultrasound showed left-sided hydronephrosis with an obstructing 7 mm calculus (Figure 1) and large amounts of free peritoneal fluid.
Free peritoneal fluid.
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fig2
CT of the abdomen without contrast confirmed the presence of extensive free fluid (Figure 2), predominantly along the paracolic gutters and extending under the hemidiaphragms with "scalloping" of the liver.
Distended sigmoid colon.
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fig3
The sigmoid colon was markedly distended (Figure 3) with faeces lifting it out of the pelvis to the level of L2. Intraoperatively a distended sigmoid colon predominantly occupied the true pelvis (Figure 3), but there was no evidence of bowel ischaemia.