Ureteric transection at Caesarean section

Case contributed by Dr Vikas Shah

Presentation

Had emergency Caesarean section. Urinary bladder high in lower segment and concern about ureteric injury.

Patient Data

Age: 25 years
Gender: Female
CT

CT abdomen and pelvis with additional delayed phase

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 Caesarean section are present. No large pelvic haematoma.

CT

Further CT 60 minutes later to examine level of right 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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Case information

rID: 55591
Case created: 15th Sep 2017
Last edited: 18th Sep 2017
System: Urogenital
Inclusion in quiz mode: Included

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