Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Case Study
  • Published:

Delayed diagnosis of ureteropelvic junction avulsion in a child owing to unstable hemodynamics

Nature Reviews Urology volume 6, pages 509–512 (2009)Cite this article

Abstract

Background. A 7-year-old previously healthy girl was injured in a traffic accident and presented to the emergency room with abdominal pain, microscopic hematuria, and wide skin defects and deep lacerations on the left flank, left upper abdomen, and right inguinal area. Initial CT of the abdomen was unremarkable. 3 weeks later, the patient complained of abdominal distension, left flank pain, and fever.

Investigations. Blood and urine tests, CT of the abdomen, chest X-ray, antegrade pyelography, intravenous urography, renal ultrasonography and diuretic renal scan.

Diagnosis. Complete avulsion injury of the left ureteropelvic junction

Management. The patient underwent 11 plastic reconstructive surgeries, including a skin grafting operation. A percutaneous nephrostomy was performed for temporary diversion. After complete healing of the left flank wound, open pyeloplasty was performed to create a ureteropelvic anastomosis with stent. The patient was discharged 1 week after surgery and the stent was removed 5 weeks later. 5 years after pyeloplasty, her renal function was normal and she had experienced no complications.

Access through your institution
Buy or subscribe

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Initial CT of the abdomen.
Figure 2: CT of the abdomen at 3 weeks after injury.
Figure 3: Antegrade pyelography at 9 months after injury.
Figure 4: Diuretic renal scan at 5 years after pyeloplasty.

References

  1. Reznichek, R. C., Brosman, S. A. & Rhodes, D. B. Ureteral avulsion from blunt trauma. J. Urol. 109, 812–816 (1973).

    Article  CAS  Google Scholar 

  2. Zufall, R. Traumatic avulsion of the upper ureter. J. Urol. 85, 246–248 (1961).

    Article  CAS  Google Scholar 

  3. Forbes, C. D., Craig, J. A., Prentice, C. R. M. & Sutherland, R. Rupture of the ureter due to crushing injury in a boy with severe hemophilia. Br. J. Surg. 58, 931–934 (1971).

    Article  CAS  Google Scholar 

  4. Boone, T. B., Gilling, P. J. & Husmann, D. A. Uretero pelvic junction disruption following blunt abdominal trauma. J. Urol. 150, 33–36 (1993).

    Article  CAS  Google Scholar 

  5. Al-Jasser, A. & Onoura, V. C. Delayed bilateral uretero pelvic junction obstruction from blunt trauma. Ann. Saudi Med. 12, 403–405 (1992).

    Article  CAS  Google Scholar 

  6. Boston, V. E. & Smyth, B. T. Bilateral pelvi-ureteric avulsion following closed trauma. Br. J. Urol. 47, 149–151 (1975).

    Article  CAS  Google Scholar 

  7. Bartley, O., Ekdahl, P. H. & Wahlqvist, L. Rupture of the ureter with pseudocyst formation. Acta Chirurg. Scand. 132, 390–396 (1966).

    CAS  Google Scholar 

  8. Kawashima, A., Sandler, C. M., Corriere, J. N., Rodgers, B. M. & Goldman, S. M. Ureteropelvic junction injuries secondary to blunt abdominal trauma. Radiology 205, 487–492 (1997).

    Article  CAS  Google Scholar 

  9. White, M. A., Kepros, J. P. & Zuckerman, L. J. Bilateral partial ureteropelvic junction disruption after blunt trauma treated with indwelling ureteral stents. Urology 69, 384.e15–e17 (2007).

    Article  Google Scholar 

  10. Mulligan, J. M., Cagiannos, J., Collins, J. P. & Millward, S. F. Ureteropelvic junction disruption secondary to blunt trauma: excretory phase imaging (delayed films) should help prevent a missed diagnosis. J. Urol. 159, 67–70 (1998).

    Article  CAS  Google Scholar 

  11. McGinty, D. M. & Mendez, R. Traumatic ureteral injuries with delayed recognition. Urology 10, 115–117 (1977).

    Article  CAS  Google Scholar 

  12. Kattan, S. Traumatic pelvi-ureteric junction disruption. How can we avoid delayed diagnosis? Injury 32, 797–800 (2001).

    Article  CAS  Google Scholar 

  13. Cass, A. S. Immediate radiological evaluation and early surgical management of genitourinary injuries from external trauma. J Urol. 122, 772–774 (1979).

    Article  CAS  Google Scholar 

  14. Morey, A. F., McAninch, J. W., Tiller, B. K., Duckett, C. P. & Carroll, P. R. Single shot intraoperative excretory urography for the immediate evaluation of renal trauma. J. Urol. 161, 1088–1092 (1999).

    Article  CAS  Google Scholar 

  15. Carlton, C. E., Scott, R. & Guthrie, A. G. The initial management of ureteral injuries: a report of 78 cases. J. Urol. 105, 335–340 (1971).

    Article  Google Scholar 

  16. Steer, W. D., Carriere, J. N., Benson, G. S. & Boileau, M. A. The use of indwelling ureteral stents in managing ureteral injuries due to external violence. J. Trauma 25, 1001–1003 (1985).

    Article  Google Scholar 

Download references

Acknowledgements

This work was supported for 2 years by Pusan National University Research Grant.

Author information

Authors and Affiliations

  1. Department of Urology, Kosin University College of Medicine, Busan, Korea

    Jae Min Chung

  2. Department of Pediatrics and Adolescent Medicine, Pusan National University School of Medicine, Yangsan, Korea

    Su Yung Kim

  3. Department of Urology, Pusan National University School of Medicine, Yangsan, Korea

    Sang Don Lee

Authors
  1. Jae Min Chung
    View author publications

    Search author on:PubMed Google Scholar

  2. Su Yung Kim
    View author publications

    Search author on:PubMed Google Scholar

  3. Sang Don Lee
    View author publications

    Search author on:PubMed Google Scholar

Corresponding author

Correspondence to Sang Don Lee.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chung, J., Kim, S. & Lee, S. Delayed diagnosis of ureteropelvic junction avulsion in a child owing to unstable hemodynamics. Nat Rev Urol 6, 509–512 (2009). https://doi.org/10.1038/nrurol.2009.148

Download citation

  • Issue date:

  • DOI: https://doi.org/10.1038/nrurol.2009.148

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing