Presentation
Right ovarian cancer with recurrence. Status post right salpingo-oophorectomy. Complaints of severe right iliac fossa pain. Recent laparoscopic procedure.
Patient Data
Urgent CT urography (oral water and IV contrast):
Right kidney: is of average size and normal site, showing minimal to mild hydronephrotic changes. No stones or soft tissue masses.
The right ureter demonstrated an interrupted course at its pelvic portion, surrounded by adjacent pockets of fluid collection measuring 1.9 x 3.8 cm and 1.4 x 2.0 cm. In the delayed phase, there is extra-ureteric contrast leakage seen filling the aforementioned pockets, extending freely into the pelvic region and left lumbar region. The distal segment of the right ureter (about 4.3 cm from the urinary bladder) is seen opacified at the early delayed phase, reaching the vesica-ureteric junction.
In addition, there is thickening seen at the adjacent bowel loops, possibly reactive.
Moreover, there are multiple mesenteric fat strands (seen mainly in the left iliac region) that are possibly reactive.
Mild-free abdominal collection was seen in the perihepatic, perisplenic, and pelvic regions that showed contrast opacification of the pelvic component (at delayed phases).
The urinary bladder is adequately distended, thin-walled, and has no stones or soft tissue masses.
Impression:
The above-described radiological appearance suggests a right partial ureteric injury with subsequent abdominal collection or urinoma and minimal to mild hydronephrotic changes.
Clinical data: right salpingooopherectomy with right ureteric injury and double J stent insertion.
The study was requested to assess the position of the stent.
Urgent plain CT of the abdomen and pelvis.
A right-side double J stent is seen with its upper end coiled in the lower calyx of the right kidney and its lower end in the urinary bladder.
The urinary bladder is seen almost empty, with a Foley catheter balloon seen inside as well.
No hydronephrotic changes.
A mild amount of pelvic fluid is seen, showing relatively high density with an almost stable.
amount compared to the previous CT. No definite peri-hepatic or peri-splenic fluid is seen.
Impression:
A right-side double J stent as described.
Case Discussion
Right ovarian cancer underwent surgical excision, and recurrence occurred. Status post-laparoscopic right salpingo-ophorectomy. CT showed a right ureteric injury managed by a right double J stent insertion.
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