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Trauma Ureter

Ureteric injuries are rare, accounting for 1-2.5% of cases, but can occur from iatrogenic causes like surgery, penetrating trauma like gunshots, or blunt trauma from deceleration injuries. Iatrogenic injuries most commonly result from ligation, crushing with clamps, partial transection, or thermal damage during open, laparoscopic, or endoscopic procedures. Missed ureteric injuries can lead to urinoma formation, ureterovaginal fistulas, or ureterovesicle fistulas, causing symptoms like fever, peritonitis, flank pain, or paralytic ileus. Investigations like IV pyelography can detect abnormalities like ureteral dilation

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17 views8 pages

Trauma Ureter

Ureteric injuries are rare, accounting for 1-2.5% of cases, but can occur from iatrogenic causes like surgery, penetrating trauma like gunshots, or blunt trauma from deceleration injuries. Iatrogenic injuries most commonly result from ligation, crushing with clamps, partial transection, or thermal damage during open, laparoscopic, or endoscopic procedures. Missed ureteric injuries can lead to urinoma formation, ureterovaginal fistulas, or ureterovesicle fistulas, causing symptoms like fever, peritonitis, flank pain, or paralytic ileus. Investigations like IV pyelography can detect abnormalities like ureteral dilation

Uploaded by

ira kumalasari
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Ureteric Injury

Epidemiology
• Rare-----
Small size
Mobilility
Protected by vertebrae,bony pelvis & muscle
• 1-2.5%
ETIOLOGY
- Commonest: Iatrogenic….. open, laparscopy, endoscopy
- Penetrating…….Gunshot injury
- Blunt trauma : Deceleration injury
IATROGENIC INJURY------MECHANISM
Ligation/kinking
Crushing by a clamp
Partial/incomplete transection
Thermal injury
Ischemia from devascularisation
HISTORY /PHYSICAL EXAM
• High degree of suspicion
• Hematuria :poor sensitivity…50-75%
• Iatrogenic :IV dye Indigo carmine intra op
CLINICAL FEATURES OF MISSED INJURY
1)URINOMA formation ……
-Persistant low grade fever
-Peritonitis
-Flank pain
-Paralytic ileas
2)ureterovaginal fistula
3)ureterovesicle fistula
RADIOLOGICAL INVESTIGATIONS
IVP(WITH LATERAL FILMS)
Abnormal findings are :
- ureteral defiation or dilation
- Incomplete deviation of total ureter
- Delayed or no visualization of renal unit
- Urinary/contrast extravasation
MANAGEMENT
1. History & physical examination
2. Investigation
3. Treatment

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