Abstract
Introduction
Ureteric injuries are rarely associated with spinal trauma with an incidence of less than 1%. Missed injuries can lead to urinoma collection, urosepsis and even death.
Materials and methods
A 75-year-old man presented 1 month following fall with high-grade fever and severe back pain mimicking spondylodiscitis clinically. Plain radiograph showed features of ankylosing spondylitis with a suspicious trans-discal injury at L3–L4. Hyper-intense fluid within L3/L4 disk space communicating to a large psoas collection measuring 13 × 6 cms mimicking spondylodiscitis with abscess formation was observed in magnetic resonance imaging (MRI). MRI with contrast enhancement demonstrated a leak through left ureter into the psoas muscle raising suspicion of a ureteric injury. Plain computerized tomography revealed a three-column fracture at L4, and a ureteric leak into the psoas collection with proximal hydronephrosis was seen after contrast administration, establishing the presence of a ureteric fistula resulting in urinoma.
Results
Following initial symptomatic improvement after ureteric stenting, the patient succumbed to urosepsis at 3 months.
Conclusion
We report for the first time a post-traumatic urinoma secondary to ureteric injury clinically mimicking spondylodiscitis. Clinicians need to be aware of the possibility of ureteric injury in hyperextension lumbar fractures occurring in ankylosing spondylitis and treat them early to avoid urological complications.
References
Engelsgjerd JS, LaGrange CA (2019) Ureteral injury. In: StatPearls [Internet]. StatPearls Publishing, Treasure Island. [cited 2019 Nov 2]. http://www.ncbi.nlm.nih.gov/books/NBK507817/
Titton RL, Gervais DA, Hahn PF, Harisinghani MG, Arellano RS, Mueller PR (2003) Urine leaks and urinomas: diagnosis and imaging-guided intervention. Radio Gr 23(5):1133–1147
Pereira BM, Ogilvie MP, Gomez-Rodriguez JC, Ryan ML, Peña D, Marttos AC et al (2010) A review of ureteral injuries after external trauma. Scand J Trauma Resusc Emerg Med 3(18):6
Goldwasser J, Wahdat R, Espinosa J, Lucerna A (2018) Urinoma: prompt diagnosis and treatment can prevent abscess formation, hydronephrosis, and a progressive loss of renal function [internet]. case reports in emergency medicine. [cited 2019 Nov 2]. https://www.hindawi.com/journals/criem/2018/5456738/
Hajiha M, Sowerby RJ, Pace KT (2017) A rare ureteral injury following posterior approach lumbar discectomy. J Endourol Case Rep 3(1):158–161
Flynn DE, Caroline DF, Gembala RB, Ball DS, Radecki PD, Cohen GS (1993) Urinoma secondary to surgical spinal fusion: radiologic diagnosis and treatment. Abdom Imaging 18(3):292–294
Gayer G, Caspi I, Garniek A, Hertz M, Apter S (2002) Perirectal urinoma from ureteral injury incurred during spinal surgery mimicking rectal perforation on computed tomography scan. Spine 27(20):E451–E453
Chaudhary SB, Hullinger H, Vives MJ (2011) Management of acute spinal fractures in ankylosing spondylitis. ISRN Rheumatol [Internet]. [cited 2019 May 29]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263739/
Anwar F, Al-Khayer A, Joseph G, Fraser MH, Jigajinni MV, Allan DB (2011) Delayed presentation and diagnosis of cervical spine injuries in long-standing ankylosing spondylitis. Eur Spine J 20(3):403–407
Westerveld LA, Verlaan JJ, Oner FC (2009) Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J 18(2):145–156
Kelley’s Textbook of Rheumatology, 9th edn [Internet]. [cited 2019 May 29]. https://www.elsevier.com/books/kelleys-textbook-of-rheumatology/9781437717389
Slobogean GP, Tredwell SJ, Masterson JST (2007) Ureteropelvic junction disruption and distal ureter injury associated with a Chance fracture following a traffic accident: a case report. J Orthop Surg Hong Kong 15(2):248–250
Oh I-S, Chang D-G, Kim Y-H, Ha K-Y (2013) Pure hyperextension injury of the lower lumbar spine with an ureteral impingement. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 22(Suppl 3):S353–S356
Pillai SB, Hegde P, Venkatesh G, Iyyan B (2013) Ureteral injury after posterior lumbar discectomy with interbody screw fixation. BMJ Case Rep [Internet]. [cited 2019 Nov 3]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822177/
Eltorai IM, Hovey RM, Ronningen LD, Montroy RE, Gutierrez PA, Aesquivel L (2003) Giant urinoma in spinal cord injury: report of two cases. J Spinal Cord Med 26(4):404–408
Kawasaki S, Shigematsu H, Matsumori H, Maegawa N, Tanaka Y (2018) Ureteral injury as a possible complication of vertebral fracture in a patient with ankylosing spinal hyperostosis. J Orthopaedic Sci 23(1):194–196
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Soundararajan, D.C.R., Maheswaran, A., Kumarasamy, D. et al. Delayed presentation of urinoma mimicking spondylodiscitis secondary to ureteric injury following carrot stick fracture in ankylosing spondylitis. Eur Spine J 29 (Suppl 2), 171–175 (2020). https://doi.org/10.1007/s00586-020-06408-5
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DOI: https://doi.org/10.1007/s00586-020-06408-5