Traumatic urine leak

Discussion:

Blunt abdominal injury resulting in left superior pole collecting system injury and urine leak. 

A few observations/teaching points:

  • Outside facility CT inappropriately did NOT have delayed images. Trauma scans positive for any significant injury should get delayed images, particularly in the setting of hemoperitoneum. As a result, the urine leak was not immediately appreciated. 
  • Clot filling and obstructing the collecting system can be fairly subtle, and is best appreciated with delayed, excretory phase images. 
  • A small urine leak (such as this one) was successfully managed non operatively. Ureteroscopy performed on day 2 showed resolution of the clot and mild hydronephrosis, with temporary double J stent placed to facilitate healing. 
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