|Year : 2001 | Volume
| Issue : 1 | Page : 75-77
Ureteral entrapment in traumatic sacroiliac joint dislocation - a rare injury
Ranjith Shetty, Joseph Thomas, Sripathy Rao
Department of Urology and Orthopaedics, Kasturba Medical College, Manipal., India
Urology Unit II, Kasturba Medical College, Manipal (Karnataka) - 576 119
Source of Support: None, Conflict of Interest: None
Keywords: Ureteric Entrapment; Sacroiliac Joint Dislocation.
|How to cite this article:|
Shetty R, Thomas J, Rao S. Ureteral entrapment in traumatic sacroiliac joint dislocation - a rare injury. Indian J Urol 2001;18:75-7
| Case Report|| |
A 21-year-old male patient was admitted through the emergency department following a road traffic accident. He had fractures of the left superior and inferior pubic rami and intracapsular fracture neck of the left femur and suspected blunt injury of the abdomen. As peritoneal tap revealed blood, emergency laparotomy was done which revealed splenic injury and a non-expanding retroperitoneal hematoma on the right side, which was not disturbed. Postoperatively the patient was on a tracheostomy with supportive ventilation for the multiple injuries. Fracture neck of the left femur was treated by Richard's fixation after one month of conservative management. On the second day after fixation, a large mass occupying the right side of the abdomen was noticed. It was found to be of fluid nature by ultrasound and extended around the right kidney with mild dilatation of the right pelvicalyceal system. Intravenous pyelogram showed extravasation of the contrast on the right side and the ureter was not opacified [Figure - 1]. Right retrograde ureterogram showed complete obstruction of the ureter at the level of the right sacroiliac joint [Figure - 2]. A percutaneous drain was introduced as a temporary measure which drained about 600 - 800 ml of urine daily.
Exploration was done after one month. The upper ureter was dilated upto the level of the right sacroiliac joint.
The ureter then dipped into the joint and could not be dissected out. Dissection of the lower ureter was not carried out. A Boari flap reconstruction of the affected ureteral segment was then carried out. Isotope renogram done after stent removal showed good function and drainage of the right kidney.
| Discussion|| |
The mechanism of ureteral entrapment in sacroiliac joint dislocation is depicted in [Figure - 3]. Severe trauma causes Type III antero-posterior compression fracture of the pelvis with "open book" dislocation of the sacroiliac joint. Entrapment of the ureter of this nature is an extremley rare injury and only two cases have been reported. In one case the ureter was entrapped during reduction of a pelvic fracture in a six-year-old boy. In the second case ureter was found entrapped in the sacroiliac joint during emergency exploration for rapture bladder associated with fracture pelvis. The ureter could be released with intraoperative traction and it was found to be viable.
In the case presented there was no fracture and the injury could be due to a separation of the sacroiliac joint which entrapped the ureter. The resulting obstruction to the right kidney was missed in the initial evaluations and could be diagnosed only when it had produced a large collection due to a possible decompression by forniceal tear. Most of the traumatic ureteral injuries are missed at the initial presentation. Due to delay in diagnosis and long segment of ureteral loss in this case Boari flap reconstruction had to be carried out.
| References|| |
|1.||Konety BR, Xerogeanes J, Carral DA et al. Ureteral entrapment in the sacroiliac joint in pelvic trauma. J Trauma 1996; 40: 150-151. |
|2.||Noakes JE, Wese FX, Churchill BM. Ureteral entrapment injury in blunt pelvic trauma: a case report. Klasen HJ. Entrapment of the ureter following indirect reduction of an acetabular fracture - A case report. J Urol 1982: 127: 764-765. |
|3.||Campbell EW Jr, Filderman PS, Jacobs SC. Ureteral injury due to blunt and penetrating trauma. Urology 1992: 40: 216-220. |
[Figure - 1], [Figure - 2], [Figure - 3]