Traumatic ureteric rupture

High speed MVA with increasing. Increasing right sided abdominal pain and distension 8 hours post presentation with oliguria prompted repeat CT. Earlier CT abdomen and pelvis with contrast was performed with some right sided perinephric fluid.

Bilateral upper pole renal infarcts, likely due to traumatic small vessel dissection. Right sided perinephric fluid and dilated proximal ureter raise concern for ureteric rupture.

Non-contrast CT of the abdomen reveals extensive~ 8 hours post initial CT. Extensive extravasation of contrast into the right perinephric space and into the pelvispelvis is seen. No contrast is seen the distal right ureter. Findings are in keeping with proximal ureteric rupture. 

Intraoperative fluoroscopy demonstrates complete extravasation of contrast from the proximal ureter, confirming the diagnosis of complete transection of the right proximal ureter.