Bilateral upper ureteric disruptions caused by a traffic accident

Bilateral ureteropelvic disruption following blunt abdominal trauma: case report

Background

Ureteral injury occurs in less than 1% of blunt abdominal trauma cases, partly because the ureters are relatively well protected in the retroperitoneum. Bilateral ureteral injury is extremely rare, with only 10 previously reported cases. Diagnosis may be delayed if ureteric injury is not suspected, and delay of 36 hours or longer has been observed in more than 50% of patients with ureteric injury following abdominal trauma, leading to increased morbidity.

Case presentation

A 29-year-old man was involved in a highway motor vehicle collision and was ejected from the front passenger seat even though wearing a seatbelt. He was in a preshock state at the scene of the accident. An intravenous line and left thoracic drain were inserted, and he was transported to our hospital by helicopter. Whole-body, contrast-enhanced computed tomography (CT) scan showed left diaphragmatic disruption, splenic injury, and a grade I injury to the left kidney with a retroperitoneal haematoma. He underwent emergency laparotomy. The left diaphragmatic and splenic injuries were repaired. Although a retroperitoneal haematoma was observed, his renal injury was treated conservatively because the haematoma was not expanding. In the intensive care unit, the patient's haemodynamic state was stable, but there was no urinary output for 9 hours after surgery. Anuresis prompted a review of the abdominal x-ray which had been performed after the contrast-enhanced CT. Leakage of contrast material from the ureteropelvic junctions was detected, and review of the repeat CT scan revealed contrast retention in the perirenal retroperitoneum bilaterally. He underwent cystoscopy and bilateral retrograde pyelography, which showed bilateral complete ureteral disruption, preventing placement of ureteral stents. Diagnostic laparotomy revealed complete disruption of the ureteropelvic junctions bilaterally. Double-J ureteral stents were placed bilaterally and ureteropelvic anastomoses were performed. The patient's postoperative progress was satisfactory and he was discharged on the 23^rd day.

Conclusion

Diagnosis of ureteral injury was delayed, although delayed phase contrast-enhanced CT and abdominal x-rays performed after CT revealed the diagnosis early. Prompt detection and early repair prevented permanent renal damage and the necessity for nephrectomy.

Bilateral Partial Ureteropelvic Junction Disruption After Blunt Trauma Treated with Indwelling Ureteral Stents

Ureteral injury secondary to blunt trauma is rare. Bilateral ureteropelvic disruptions have only been reported eight times previously. A high index of suspicion must guide the appropriate evaluation, and the severity of the disruption will determine the management options. We present the case of a 63-year-old man who had fallen from his roof and subsequently partially disrupted both ureteropelvic junctions and was treated conservatively with indwelling ureteral stents. To our knowledge, this is the first documented case of conservative management of bilateral ureteropelvic junction disruption with indwelling ureteral stents.

Ureteropelvic junction disruption following blunt abdominal trauma

We report here on a case of avulsion of the ureteropelvic junction in a 7-year-old boy who was injured in a car accident. Severe brain trauma took precedence over signs and symptoms of blunt abdominal trauma, but 24 hours after the accident, progressive distension of the abdomen required further evaluation. Ultrasound examination and a computed tomography scan revealed disruption of the ureteropelvic junction. Simple primary anastomosis was performed. We discuss the characteristics of this unusual injury and include a review of the literature.