Gulpinar M T, Keskin S K, Yildirim A, Caskurlu T
Department of Urology, çanakkale Onsekiz Mart University Hospital, Western Marmara, çanakkale, Turkey.
Department of Urology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Dumlupınar, Kadıköy/ıstanbul, Turkey.
Niger J Clin Pract. 2017 May;20(5):642-644. doi: 10.4103/1119-3077.206365.
Ureteral injuries due to gunshots are tend to be misdiagnosed because of concomitant vascular and intraabdominal organ wounds. Our case is a 23-year-old man who was admitted to the hospital with multiple abdominal gunshot wounds. Laboratory findings showed worsening anemia, and the computed tomography (CT) scan showed multiple lead bullets inside the abdomen and retroperitoneum. Patient was then taken to the operation room for laparatomy. There were many intestinal injuries and also a stable retroperitoneal hematoma. There was no ureteral injury mentioned in the operation note or the initial CT report. Two weeks after this operation, the patient developed significant urine leakage from the abdominal wounds. Ureteral J stent placement was our first choice of treatment. This was complicated with a late ureteral obstruction. The final treatment was an ureteroureterostomy. Diagnosing ureteral injuries due to traumatic causes can be hard in most of the cases. Physicians should consider early evaluation of the patient for ureteral leakage if there is suspicion about ureteral injury.
由于枪伤导致的输尿管损伤往往因合并血管和腹腔内器官损伤而被误诊。我们的病例是一名23岁男性，因多处腹部枪伤入院。实验室检查结果显示贫血加重，计算机断层扫描（CT）显示腹部和腹膜后有多发铅弹。患者随后被送往手术室进行剖腹手术。有多处肠道损伤，还有一个稳定的腹膜后血肿。手术记录或最初的CT报告中均未提及输尿管损伤。此次手术后两周，患者腹部伤口出现大量尿液渗漏。输尿管支架置入术是我们的首选治疗方法。这一治疗出现了晚期输尿管梗阻的并发症。最终治疗方法是输尿管输尿管吻合术。在大多数情况下，诊断创伤性输尿管损伤可能很困难。如果怀疑有输尿管损伤，医生应考虑对患者进行早期输尿管渗漏评估。
