Blunt Ureteropelvic Junction Disruption

Abstract

2 previously healthy 41-year-old woman fell off a horse nto her left side. She was not trampled and was able to emount and ride home. She later became lightheaded nd presented to our trauma center. Physical examinaion revealed left lower quadrant and left flank tenderess. A Foley catheter was inserted and hematuria was oted. CT of the abdomen with intravenous contrast emonstrated a urinoma tracking over the left psoas uscle. Delayed CT image (Fig. 1) and volumeendered CT reconstruction (Fig. 2) of the kidneys deict ureteropelvic junction (UPJ) injury (Figs. 1A, 2A, rrow) with preferential drainage into the urinoma (Figs. B, 2B). Rigid cystourethroscopy with a left retrograde yelogram confirmed the laceration of the left renal pelis. A double J ureteral stent was placed. Hematuria esolved on hospital day 4 and the patient was disharged home. Ureteropelvic junction injury resulting from blunt rauma is an uncommon and often elusive injury with freuent delays in diagnosis. Approximately two-thirds of the PJ injuries occur in children, more commonly on the ight side. The pathogenesis of this injury is not well estabished. Theories of injury include avulsion caused by severe ateral flexion of the torso and cephalad distraction of the idney, and disruption caused by compression of the UPJ gainst the ribs, or transverse processes. Severe lateral flex1