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8 juillet 2011 5 08 /07 /juillet /2011 13:30

 

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ROYAL MONACO RIVIERA WEB MAGAZINE

 

 

MEDICINE & CHINESE TRADITIONAL MEDICINE

 

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Luigi Mattera is a certified by CERFPA (St. Laurent du Var-France) in HOMEOPATHY & ZUO TUINA MASSAGE OF TRADITIONAL CHINESE MEDICINE - Online certificate from TEXAS CHIROPRACTIC COLLEGE (Pasadena-Texas 2007) in CHIROPRACTIC SPORTS & CHIROPRACTIC TREATMENT OF GOLF INJURIES


 

 

PRESENTS:

Welcome to BMC Urology published by BioMed Central BMC Urology is an open access journal publishing original peer-reviewed research articles in all aspects of the prevention, diagnosis and management of urological disorders, as well as related molecular genetics, pathophysiology, and epidemiology. BMC Urology (ISSN 1471-2490) is indexed/tracked/covered by PubMed, MEDLINE, CAS, EMBASE, Scopus and Google Scholar.

 

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Bilateral ureteropelvic disruption following blunt abdominal trauma: Case report

Fumiaki Iwase email, Yoshibumi Miyazaki email, Tastuho Kobayashi email, Hiroko Kikuchi email and Kiyoshi Mastuda email

BMC Urology 2011, 11:14doi:10.1186/1471-2490-11-14

 
Published: 7 July 2011

Abstract (provisional)

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 23rd 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.

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