Presentation
Multiple stab wounds to the abdomen. Taken immediately to theater, with intra-operative findings of multiple gastrointestinal tract and mesenteric injuries. Now 2 weeks post-op with ongoing low grade fevers and abdominal pain.
Patient Data
Large right perirenal collection, which extends into the right psoas major muscle as inferiorly as the right sacroiliac joint, amenable to image-guided drainage. There is a much smaller separate multiloculated collection posterolaterally.
Mild right hydronephrosis.
Subcutaneous nodule in the right inguinal region and marked thickening of the left rectus abdominis muscle.
Bibasal pleural fluid collections and atelectasis.
Planning CT for insertion of drainage catheters
The patient was referred for insertion of a drain. Right posterior pararenal and retroperitoneal collection is shown to be hyperdense, with similar density material filling the right renal pelvis and ureter.
Two drainage catheters were inserted into this collection. The fluid drained was haemoserous. A creatinine level was requested on this fluid, which came back at 5697 umol/L, compatible with a urine leak.
Case Discussion
This case demonstrates transection of the right ureter, with formation of a urinoma. On the initial CT the clue was the hydronephrosis, however it would have been a difficult diagnosis to make. The subsequent CT shows dense fluid in the collection, similar to the contents of the urinary collecting system. While clotted blood may have a similar density, the very homogeneous nature would have been unusual. Additionally, the drained fluid did not have the appearance of blood.
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