PMC4759969_01
(a) Volume rendering an image of the excretory phase of the computed tomography urography shows contrast leak at the distal ureter (arrows). (b) Retrograde ureterogram shows contrast leak from the pelvic portion of the left ureter (arrows). A guide wire (arrowheads) was introduced into the left pelvic collection. (c) Lateral image shows the antegrade transnephrostomic guidewire (arrowheads) intersecting with the retrograde ureteric wire (black arrow) in the pelvic collection. The tip of the sheath is introduced into the collection cavity (arrow). (d) Digital subtraction nephrostogram at 1-month shows partial healing of the ureter and decrease in the fistula. (e) 4-month follow-up shows complete healing of the transected ureter and resolution of the uretero-rectal fistula. (f) Retrograde urethrogram during double J stent removal at 1 year showed no leak or ureteric stricture at the site of the previous injury
AJM-6-28-g001.jpg
PMC4759969_01_AJM-6-28-g001.jpg
F1
This demonstrated a large collection in the left iliac fossa with evidence of urine leak from the distal left ureter [Figure 1a]. Cystoscopy was done, and left ureteric cannulation showed total ureteric transection of the ureter and contrast leak into the left pelvic collection [Figure 1b]. A 9 Fr 35 cm sheath was introduced into the left pelvic collection and a 15 mm gooseneck snare was inserted to capture the retrograde ureteric wire, which was retrieved from the percutaneous sheath to gain a through-and-through access [Figure 1c]. At 1-month follow-up, nephrostogram showed remarkable healing of the ureter with interval decrease in the uretero-rectal fistula [Figure 1d]. At 4-month follow-up, there was complete healing of the ureter and resolution of the uretero-rectal fistula [Figure 1e]. Follow-up retrograde urethrogram during double J stent removal showed at 1 year no leak or ureteric stricture at the site of the previous injury [Figure 1f].
PMC4759969_02
Computed tomography scan of the abdomen in early (a) and delayed (b) phases. The late images demonstrate leakage of contrast into the retroperitoneum from the site of injury just below the pelvi-ureteric junction and communicating with a large peritoneal collection. (c) Nephrostogram demonstrates interruption of the proximal ureter with contrast leak into the perinephric collection. (d) Oblique view showing the captured wire by a gooseneck snare into the percutaneously introduced sheath from the upper pole. (e) Double J ureteric stent and nephrostomy catheter in position
AJM-6-28-g002.jpg
PMC4759969_02_AJM-6-28-g002.jpg
F2
A CT scan of the abdomen revealed a large left perinephric and intraperitoneal fluid collection that showed increased density on the delayed phase due to urine leak from proximal ureteric injury [Figure 2a and b]. An 8 Fr 24 cm double J stent was inserted, and a nephrostomy tube was kept in place for external drainage [Figure 2c-e].