Bilateral pelvi-ureteric avulsion following closed trauma

Area of Science:

• Pediatric surgery
• Trauma surgery
• Urology

Background:

• Road traffic accidents can cause severe, life-threatening injuries in children.
• Bilateral pelvi-ureteric rupture is a rare but serious consequence of blunt abdominal trauma.
• Prompt diagnosis and intervention are critical for preserving renal function.

Purpose of the Study:

• To report a case of bilateral pelvi-ureteric rupture in a pediatric patient following a road traffic accident.
• To highlight the importance of early diagnosis and appropriate surgical management for achieving optimal functional outcomes.
• To discuss the diagnostic modalities and surgical techniques employed in managing this complex injury.

Main Methods:

• A 9-year-old female patient sustained multiple injuries in a road traffic accident.
• Intravenous pyelography revealed bilateral pelvi-ureteric rupture.
• Surgical management involved bilateral ureteral anastomosis over a polythene splint, supported by a defunctioning nephrostomy.
• Diagnostic confirmation included intravenous and retrograde pyelography.

Main Results:

• The patient required two attempts at ureteral anastomosis to restore continuity on both sides.
• Following surgical repair and a period of nephrostomy support, the patient recovered well.
• One year post-accident, both kidneys and ureters demonstrated normal function.

Conclusions:

• Early recognition and timely surgical intervention are paramount for successful management of bilateral pelvi-ureteric rupture in pediatric trauma.
• Ureteral anastomosis with splinting and temporary nephrostomy is an effective surgical strategy.
• Awareness of this injury pattern and utilization of appropriate imaging techniques facilitate diagnosis and treatment, leading to good functional results.