Delayed diagnosis of ureteropelvic junction avulsion in a child owing to unstable hemodynamics.

BACKGROUND

A 7-year-old previously healthy girl was injured in a traffic accident and presented to the emergency room with abdominal pain, microscopic hematuria, and wide skin defects and deep lacerations on the left flank, left upper abdomen, and right inguinal area. Initial CT of the abdomen was unremarkable. 3 weeks later, the patient complained of abdominal distension, left flank pain, and fever.

INVESTIGATIONS: Blood and urine tests, CT of the abdomen, chest X-ray, antegrade pyelography, intravenous urography, renal ultrasonography and diuretic renal scan.

DIAGNOSIS: Complete avulsion injury of the left ureteropelvic junction.

MANAGEMENT: The patient underwent 11 plastic reconstructive surgeries, including a skin grafting operation. A percutaneous nephrostomy was performed for temporary diversion. After complete healing of the left flank wound, open pyeloplasty was performed to create a ureteropelvic anastomosis with stent. The patient was discharged 1 week after surgery and the stent was removed 5 weeks later. 5 years after pyeloplasty, her renal function was normal and she had experienced no complications.