Ultrasonic detection of a retroperitoneal haematoma causing duodenal obstruction following ureterolithotomy

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Many authors have documented the clinical features and ultrasonic appearances of retroperitoneal haematomas which are usually a result of blunt epigastric trauma, bleeding diatheses or leaking aneurysms (McVerry et al, 1977; Foley & Teele, 1979; Shirkoda et al, 1983; Mittelstaedt, 1987). With adequate perioperative drainage, retroperitoneal haemorrhage is an uncommon complication of ureteric surgery (Straffon, 1986), although there may be an increased risk where the surgery is complicated. We present a case of duodenal obstruction resulting from a retroperitoneal haematoma following ureteric surgery diagnosed by ultrasound. A 51-year-old man, with a history of several previous operations for bilateral recurrent urinary calculi, presented with a 2-month history of intermittent right renal colic and an intravenous urogram confirmed a calculus in the distal right ureter. Following unsuccessful attempted dormia basket removal, an open ureterolithotomy was performed to remove the impacted calculus. Although scarring and adhesions from previous surgery made the operation technically difficult, he made a satisfactory recovery and was discharged after 10 days. Four days later he was re-admitted with a history of bile stained vomiting and upper abdominal distension. Abdominal examination revealed some epigastric swelling and satisfactory healing of his right lower abdominal wound. His serum amylase was normal. A barium meal confirmed an obstruction at the mid-portion of the second part of the duodenum, and appearances suggested an extramural lesion (Fig. 1). Delayed radiographs showed passage of barium distally indicating an incomplete obstruction.