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Ureteral Transection Secondary to a Penetrating Handlebar Injury

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Ureteral Transection Secondary to a Penetrating Handlebar Injury
Kaitlin (Petros) Debbink, MD, David B. Tashjian, MD, Michael V. Tirabassi, MD, Robert Gaffey and Jeffry Nahmias, MD, Baystate Medical Center, Springfield MA

Objective: Ureteral injuries occur in less than 1% of all traumas. Of these, 54% are from gunshot wounds, 5% from stab wounds, 38% from blunt trauma, and 2% other mechanisms (Siram et al). We present a case of ureteral injury secondary to a penetrating trauma from a bicycle handlebar. An otherwise healthy 13-year-old girl presented after a fall from bicycle. She was hemodynamically stable with normal vital signs and a GCS of 15. A left lower quadrant abdominal wall laceration with active bleeding was found on secondary survey. Bleeding did not cease with manual pressure and there was evidence of bowel herniation through an abdominal wall defect, thus she was taken to the operating room emergently. A laparotomy via extension of the wound revealed a sigmoid colon serosal injury and a vascular injury at the medial base of the sigmoid colon mesentery. The serosal injury was oversewn and the mesenteric vascular bleeding was controlled with ligation. Further exploration of the abdomen showed no sign of ongoing hemorrhage or other injury, thus the abdominal wall injury was closed. Due to limited exposure of the abdominal cavity secondary to exploration via the wound and microscopic hematuria, the patient underwent a CT abdomen/pelvis with IV contrast and later CT cystogram which were negative for any injuries. On post-operative day 5 the patient became distended and tender on examination with a doubling of her baseline creatinine. A repeat CT scan of the abdomen/pelvis showed massive ascites of simple fluid density. A decision was made to return to the OR for concern of a ureteral injury. Exploration via the previous wound demonstrated a complete left ureteral transection. This was repaired primarily over a double-J stent. The Foley catheter was removed the following day and the patient was discharged home on hospital day 11 (post-op days 10 and 5). The stent was removed 6 weeks later with no further complication. Ureteral injury from trauma is rare, however with any signs of violation of the retroperitoneum it must be considered. This diagnosis requires a high index of suspicion in order to perform the appropriate intraoperative assessment or radiologic imaging if not discovered at the initial exploration. This is the only known case of a ureteral injury resulting from a penetrating handlebar injury.
Objective: After this presentation, the learner will be more aware of identification of ureteral injury.Objective Content: This presentation will give an overview of one presentation of ureteral injury, discussing the obstacles to early identification and methods for diagnosis.


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