THÔNG TIN TÀI LIỆU
The physical examination may be unremarkable However, an enlarging flank mass in the absence of signs of retroperitoneal bleeding suggests urinary extravasation Hematuria is an unreliable sign The urinalysis may be normal in 30% of confirmed cases When the diagnosis has been delayed, ureteral injury may manifest with fever, chills, lethargy, leukocytosis, pyuria, bacteriuria, flank mass or pain, fistulas, urinoma, peritonitis, and ureteral strictures Management/Diagnostic Testing As mentioned above, the diagnosis of ureteral injury should be entertained when children present with penetrating abdominal injuries A CT urogram can suggest the presence of ureteral injury when the ureter does not opacify with contrast on delayed images and/or there is urinary extravasation medial to the renal hilum or along the length of the ureter Retrograde pyelogram may be considered if ureteral injury is suspected This generally requires sedation or anesthesia, and involves passing dye in a retrograde fashion from bladder into the ureter with fluoroscopic evaluation Clinical Indications for Discharge or Admission Given the strong association of ureteral injuries with other severe abdominal injuries, most children with ureteral injury are admitted to the hospital Urologic consultation is necessary for children with suspected ureteral injury These injuries require diversion of urine with a ureteral stent or nephrostomy tube Extensive injuries may require definitive repair in an immediate or delayed fashion BLADDER Goal of Treatment The goal of evaluation in the ED is recognition of bladder injuries, determining if they are extra- or intraperitoneal, and obtaining prompt urologic consultation CLINICAL PEARLS AND PITFALLS Bladder injuries may occur after blunt or penetrating trauma Blunt trauma secondary to motor vehicle accidents is the leading cause More than 80% of bladder injuries are associated with pelvic fractures; however, only 10% of patients with pelvic fractures sustain lower urinary tract injury The probability of having an associated bladder injury increases proportionally with the number of fractured pubic rami
Ngày đăng: 22/10/2022, 13:28
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