Ureter trauma: Difference between revisions
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==Background== | ==Background== | ||
[[File:Urinary system.png|thumb|'''(1) Human urinary system:''' (2) kidney; (3) renal pelvis; (4) ureter; (5) urinary bladder (6) urethra. <Br>'''Additional structures:''' (7) adrenal gland; (8) renal artery and vein; (9) inferior vena cava; (10) abdominal aorta; (11) common iliac artery and vein; (12) liver; (13) large intestine; (14) pelvis.]] | |||
[[File:Blausen 0592 KidneyAnatomy 01.png|thumb|Renal anatomy.]] | |||
[[File:PMC5265200 13244 2016 536 Fig1 HTML.png|thumb|Perinephric space with exaggerated pararenal space to show retroperitoneal structures. Perinephric bridging septa are seen between the left kidney and the adjacent renal fascia.]] | |||
*90% of non-iatrogenic injuries occur from penetrating injury | *90% of non-iatrogenic injuries occur from penetrating injury | ||
*Isolated ureter injury is rare | *Isolated ureter injury is rare |
Revision as of 21:14, 17 March 2021
Background
- 90% of non-iatrogenic injuries occur from penetrating injury
- Isolated ureter injury is rare
Clinical Features[1]
- Symptoms usually nonspecific
- Hematuria present in ~70%
- Delayed signs of occult injury include:
- Fever/sepsis, flank pain, ileus, urinary leakage or obstruction
- Complications include :
- Peritoneal or retroperitoneal urinary leakage
- Perinephric abscess
- Fistula formation (e.g. ureterovaginal, uterocutaneous)
- Ureteral stricture/obstruction
Differential Diagnosis
Abdominal Trauma
- Abdominal compartment syndrome
- Diaphragmatic trauma
- Duodenal hematoma
- Genitourinary trauma
- Liver trauma
- Pelvic fractures
- Retroperitoneal hemorrhage
- Renal trauma
- Splenic trauma
- Trauma in pregnancy
- Ureter trauma
Evaluation
- Absence of hematuria does NOT rule out ureteral injury
- If CT is nondiagnostic but high index of suspicion perform IV urography or retrograde pyelography
Management
- Surgery
Disposition
- Admit