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Delayed Diagnosis of Ureteral Injury Following Penetrating Abdominal Trauma: A Case Report and Review of the Literature

Kadhim M. Taqi, Manar Mohammed Nassr, Jihad Salim Al Jufaili, Alla Ibrahim Abu-Qasida, Joseph Mathew, Hani Al-Qadhi

(Department of General Surgery, Sultan Qaboos University Hospital, Muscat, Oman)

Am J Case Rep 2017; 18:1377-1381

DOI: 10.12659/AJCR.905702


BACKGROUND: Ureteral injuries are considered to be uncommon in cases of trauma. The possibility of damage to the ureters may not be considered in the setting of acute trauma when life-threatening injuries take clinical management priority. A case of acute ureteral injury is described in a patient with acute penetrating gunshot abdominal injury that had a delay in diagnosis, with a review of the literature.
CASE REPORT: A 29-year-old woman presented to our hospital with a missed ureteral injury following a self-inflicted gunshot injury to the abdomen. She underwent abdominal computed tomography (CT) imaging and a retrograde pyelogram, which showed complete transection of the left upper ureter with contrast extravasation and the formation of a large urinoma. She underwent a percutaneous nephrostomy and drainage of the urinoma. An end-to-end ureteric anastomosis with excision of the intervening injured ureter, or ureteroureterostomy, was performed three weeks following the diagnosis.
CONCLUSIONS: Ureteral injuries following trauma are rare, but a delay in diagnosis can be associated with clinical morbidity. A high index of clinical suspicion is important for early identification of ureteral injury in cases of acute abdominal trauma.

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