Bilateral pelvic urinomas following ureteral injury from surgery: lymphocele look-alikes on computed tomography

Abstract

Postoperative fluid collections are a not-infrequent finding on computed tomography (CT), and their causes are numerous. One of the more rare etiologies is a urinoma resulting from a ureteral injury. Such an injury is one of the most serious complications of abdominal, mainly gynecological, surgery. This complication is often clinically unsuspected, as symptoms are nonspecific and the patient may present weeks and even months after the injury. We present a patient in whom clinically unsuspected bilateral pelvic urinomas were diagnosed on a baseline CT 8 weeks after radical hysterectomy. We want to emphasize the crucial role of CT, especially with delayed scanning, in reaching this diagnosis.

Urinoma Masquerading as Post-hysterectomy Hematoma: The Role of Accurate Diagnosis and Imaging-Guided Intervention

“…Differential diagnoses of urinomas include ordinary ascites, abdominal or pelvic abscesses or hematomas, lymphoceles, cystic masses, or pancreatic pseudocysts. Seroma, bowel perforation, and enteric material leak are other differential diagnoses of post-operative fluid collection [13].…”

Imaging of Iatrogenic Complications of the Urinary Tract

“…62,63 It may also become loculated and may easily be mistaken for a seroma or lymphocele. 64 Another important indirect finding that should raise suspicion of a possible ureteral injury is ipsilateral hydronephrosis. Dilation of the collecting system often develops rapidly, within days, from ureteral injury (Figs.…”

Late aortic lymphocele and residual ovary syndrome after gynecological surgery

“…Gynecological surgery, as radical hysterectomy or pelvic and aortic lymphadenectomy, accounts for more than 50% of iatrogenic injuries [ 1 , 2 ], such as urinoma, lymphocele, haematoma, seroma or abscess [ 3 - 5 ]. Furthermore, women of reproductive age having an hysterectomy because of benign or malignant disease require the gynecologist to decide whether to preserve or to remove the gonads.…”