Bilateral distal ureteral transection in the setting of blunt trauma

Trauma Surgery & Acute Care Open
Desiree RaygorDavid Skarupa

Abstract

A 69-year-old obese man was involved in a high-speed head-on motor vehicle collision. He was tachycardic and normotensive on arrival. He subsequently developed hemodynamic instability requiring blood transfusion. On examination he had bilateral pneumothoraces, an anterior-posterior compression (APC) pelvic fracture, an open wound at the left groin, and gross hematuria after Foley catheter placement.CT imaging revealed hemoperitoneum, right hepatic lobe grade II lacerations, splenic laceration, mesenteric root injury with extravasated contrast, intraperitoneal and extraperitoneal bladder rupture, bilateral ureteral injuries at the level of the pelvic inlet (see figure 1), APC pelvic fracture, bilateral rib fractures, pneumothoraces, and pulmonary contusions.Figure 1CT of the abdomen and pelvis with cystogram. Delayed images demonstrating accumulation of contrast in the retroperitoneum arising from the right and left ureter at the level of the pelvic brim. Extraluminal contrast from the intraperitoneal bladder injury is also identified.He underwent emergent exploratory laparotomy. Exploration confirmed the injuries noted on the CT scan. Hepatorrhaphy with abdominal and preperitoneal pelvic packing was performed. A large anterior ...Continue Reading

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