Pelviureteric junction obstruction - retained wire

Case contributed by Dr Ian Bickle

Presentation

Admitted with left flank pain. Large burden ureteric stone disease. Patient underwent ureteroscopy.

Patient Data

Age: 70
Gender: Male

Gross left sided hydronephrosis.

Nephrostomy tube in situ.

Loops metallic linear density in the upper left ureter.

Complete obstruction of the left PUJ ( at 15 minutes)

Annotations illustrate the metallic linear foreign body in the proximal left ureter.

It is not continuous either proximally or distally.

Left nephrostomy.

Retained broke guidewire in the proximal left ureter.

Persistent left hydronephrosis with multi-level ureteric stones.

Right ureteric stent.    Right pelvic stone.

Case Discussion

This case illustrates the need for a detective trait in a radiologist.  No mention of any intra-operative difficulty was provided to the radiologist.  

It is often the case in post operative patient's too, that the nature of the surgery or drains, packs, prosthetic material placement are not outlined.

The broken retained wire in the upper ureter resulted from a failure to pass a stricture at the PU junction at ureteroscopy.  Hence, the proximal end of the wire is curled back on itself.

For all of the cases where unsuspected iatrogenic material is identified first check it doesn't lie outside or on the patient, before continuing and making your final conclusion.  This can be a hassle with an immobile patient, but it has to be done.

Here is another example - the first thing would be to check if gauze was outside/on the patient.  

http://radiopaedia.org/cases/gossypiboma-8

It turned out not...

 

 

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Case information

rID: 31597
Case created: 17th Oct 2014
Last edited: 11th Sep 2015
System: Urogenital
Inclusion in quiz mode: Included

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