Post-hysterectomy ureteral ligation

Case contributed by Hidayatullah Hamidi
Diagnosis almost certain

Presentation

History of hysterectomy one week back. Acute right flank pain thereafter.

Patient Data

Age: 30 years
Gender: Female

Pre-contrast images show no radiodense stone in the urinary tract.

Delayed parenchymal enhancement of the right kidney with a dense nephrogram (after 3 hours).

24-hour delayed images show opacification of a moderately dilated right renal collecting system and ureter down to the distal end.

No free intraabdominal contrast spillage is seen.

Post-surgical inflammatory changes and evidence of a collection in the pelvis.

Case Discussion

Right-sided dense nephrogram with mild to moderate hydroureteronephrosis down to the distal part suggestive of acute distal ureteral obstruction. Keeping in view the recent history of hysterectomy the features are most probably due to distal ureteral ligation.

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