Presentation
Had emergency Cesarean section. Urinary bladder high in lower segment and concern about ureteric injury.
Patient Data
The right kidney is hydronephrotic, enhances poorly compared to the right, with impaired excretion of contrast. The right ureter is distended down to the pelvis. The expected changes following a Cesarean section are present. No large pelvic hematoma.
Further CT 60 minutes later to examine level of Rt ureteric obstruction
With a further delay from the time of contrast administration to image acquisition, the contrast has now passed through the right kidney leaving a delayed nephrogram and a column of contrast in the ureter to an abrupt cut off approximately 3 cm proximal to the vesicoureteric junction. There is no extravasation of contrast.
Case Discussion
Injury to the distal right ureter was suspected and then confirmed by this study. Rather than contrast leaking out, the ureter goes into spasm leading to an obstructive uropathy. The ureter was stented and subsequent fluoroscopic studies showed no leak with successful resolution of the hydronephrosis.
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