Traumatic urethral transection

Case contributed by Andrew Murphy

Presentation

Fall from a moving truck.

Patient Data

Age: 40 years
Gender: Male
X-ray

Multiple left-sided rib fractures, left clavicle fracture, left 9th transverse process fracture, and a small left haemopneumothorax with left intercostal drain in situ.

 High-grade stenosis of the coeliac trunk with minor poststenotic dilatation

Complex pubic rami and left sacral ala fracture with evidence of blood within the urinary bladder and extensive pelvic haematoma. Prominent enhancement at the left base of the penis may represent a vascular injury, however there is no significant change on portal venous and delayed phases.  This injury has high correlation with urethral injury.

X-ray

Urethrogram

The Foley catheter balloon is inflated and lays in the fossa navicularis, around the level of the bulbous urethra diaphragm. There is an abrupt cut-off with extraperitoneal contrast extravasation. There is no evidence of extension into the posterior urethra or the bladder. These findings represent a traumatic urethral transection.

Residual contrast in the right hemi pelvis on the first image is due to a previous unsucessful contrast study attempt.

Case Discussion

Traumatic urethral transection secondary to pelvic fractures are not common but, when present, are associated with significant morbidity.

The injury occurs most commonly at the level of the bulbomembranous junction.

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Case information

rID: 48983
Published: 4th Nov 2016
Last edited: 23rd Sep 2018
System: Trauma
Inclusion in quiz mode: Included

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