Spontaneous ureteric rupture in the postpartum period is an extremely rare complication of childbirth, most commonly affecting the right ureter. Due to its non-specific clinical presentation, including abdominal or flank pain, diagnosis is often delayed. However, early identification and prompt management are critical to prevent complications such as urinoma, sepsis, and abscess formation.

A 28-year-old woman, gravida 2, para 1, presented two days postpartum following a normal vaginal delivery with severe right lower quadrant pain radiating to the groin. Initial evaluation suggested a urinary tract infection, and she was treated with intravenous (IV) antibiotics. However, persistent pain and imaging findings on CT intravenous pyelogram (IVP) revealed a partial rupture of the right ureter, with an associated urinoma and mild hydronephrosis. The patient subsequently developed urosepsis, requiring urgent cystoscopic retrograde stent insertion to facilitate ureteric healing. Follow-up imaging confirmed resolution, and the patient had a successful stent removal seven weeks postoperatively.

Spontaneous ureteric rupture in pregnancy and the postpartum period has been linked to mechanical obstruction, increased intra-abdominal pressure, and vascular congestion. Despite its rarity, it should be considered in postpartum patients with unexplained flank or abdominal pain. CT IVP remains the gold standard for diagnosis. Treatment options include ureteric stenting, nephrostomy placement, and in rare cases, surgical intervention.

This case highlights the importance of early recognition and imaging in postpartum patients with persistent flank pain. Timely intervention with ureteric stenting can successfully manage the condition and prevent complications. Increased awareness among clinicians is essential to facilitate prompt diagnosis and optimise patient outcomes.