A Decade-Old Giant Urinoma Following Ureteric Injury

Urinoma, a collection of urine outside the urinary tract, is an uncommon entity typically associated with trauma, obstruction, or iatrogenic injury. We report a case of a giant urinoma in a 55-year-old woman that posed a diagnostic challenge until surgical exploration. She presented with progressive abdominal distension and nonspecific pain 10 years following a left ovariotomy. Initial clinical evaluation and imaging suggested a large intra-abdominal mass with characteristics mimicking a cystic neoplasm. Despite extensive diagnostic workup, including ultrasonography, contrast-enhanced CT and MR, the precise diagnosis remained elusive.

Given the diagnostic uncertainty and worsening symptoms, surgical exploration was undertaken. Intraoperatively, a massive urinoma, measuring approximately 25 cm in diameter, was identified. Exploration of the cyst revealed an opening traced to the left ureter. The urinoma was drained, the cyst wall excised and definitive ureteric repair was performed successfully.

Histology confirmed the diagnosis of urinoma.

This case highlights the diagnostic challenges posed by giant urinomas, particularly when the presentation is atypical and imaging is equivocal. It underscores the importance of considering delayed complications from prior pelvic surgeries and the critical role of surgical exploration in resolving diagnostic dilemmas.