URETEROPELVIC JUNCTION DISRUPTION FOLLOWING BLUNT ABDOMINAL-TRAUMA

Disruptions of the ureteropelvic junction following blunt abdominal tr auma are rare. Our recent management of 8 cases (7 patients) revealed that an immediate diagnosis of this entity was made in less than 50% o f the patients. The majority of delayed diagnoses occurred when the pa tients experienced absence of hematuria associated with nonresponsive hypovolemic shock. The clinical instability of the patients required e mergency celiotomy for stabilization and precluded our obtaining appro priate contrast enhanced radiographic studies. Retroperitoneal finding s at operation failed to reveal evidence of a perinephric hematoma. Th e 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 str ess that a negative exploratory laparotomy without direct visualizatio n of the kidney should not exclude radiographic evaluations for retrop eritoneal injuries.