Presentation
Post robotic prostatectomy, patient presented with a distended abdomen with tenderness, and absent bowel movements. He vomited a few times. He had severe generalised pain but no signs of peritonitis.
Patient Data
Empty urinary bladder with a catheter in its lumen. Multiple small pockets of air in the pelvis and the anterior abdominal wall, probably related to the recent surgery. A small amount of fluid in the right paracolic gutter. Somewhat irregular large fluid collection in the right inferior quadrant. There is a linear contrast blush within the collection.
The right inferior epigastric artery is in proximity to the collection.
Little atelectasis in the right lung base. No calcified stones in the gallbladder. Unremarkable liver, pancreas, spleen, adrenal glands and kidneys. No retroperitoneal lymphadenopathy was demonstrated.
Suboptimal evaluation of the pelvis due to artefacts related to the right hip replacement.
Given the initial findings, a multiphase CT was recommended.
5 days post robotic prostatectomy, patient presented with lower abdominal pain and right supravesical fluid collection within proximity to the inferior epigastric artery with contrast blush suggesting active bleeding from an inferior epigastric artery injury.
The case was discussed with vascular surgeons who recommended further evaluation with a triphasic CT.
Supravesical fluid collection in the right lower quadrant containing contrast material in keeping with extravasation from the urinary tract.
No evidence of active bleeding. Multiple small pockets of air in the pelvis and the anterior abdominal wall are probably related to the recent surgery.
Prostatectomy. Empty urinary bladder with a urinary catheter in situ.
Mild atherosclerosis of the abdominal aorta and its main branches. No evidence of active contrast extravasations.
Case Discussion
This case is pretty unusual and professionally interesting as the first study is pretty convincing for an inferior epigastric artery injury, but a subsequent multiphase CT demonstrated that it was in fact a leak from the site of prostatectomy and the collection was a urinoma.
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