Ureteropelvic junction disruption following blunt abdominal trauma

Disruptions of the ureteropelvic junction following blunt abdominal trauma are rare. Our recent management of 8 cases (7 patients) revealed that an immediate diagnosis of this entity was made in less than 50% of the patients. The majority of delayed diagnoses occurred when the patients experienced absence of hematuria associated with nonresponsive hypovolemic shock. The clinical instability of the patients required emergency celiotomy for stabilization and precluded our obtaining appropriate contrast enhanced radiographic studies. Retroperitoneal findings at operation failed to reveal evidence of a perinephric hematoma. The kidneys were palpably normal and, therefore, they were not directly examined. Despite these negative retroperitoneal findings the patients sustained disruption of the ureteropelvic junction. Therefore, we stress that a negative exploratory laparotomy without direct visualization of the kidney should not exclude radiographic evaluations for retroperitoneal injuries.