12-year-old girl who while playing
On the street he slipped, hitting the string-rope
the vereda on the right flank, two hours later
presented progressive pain and macroscopic hematuria.
She was admitted with hemodynamic instability.
120 beats per minute, 18 breaths
blood pressure of 110/60 mmHg
The
physical examination only identified multiple excoriations
pain on tightening of the chest
peritoneal irritation.
The laboratory
showed a hematocrit of 27% and an analysis
More than 200 red blood cells per field of urine
increased.
An ultrasound showed a collection
right perirenal and axial tomography
Abdominal computed unenhanced showed an abnormal
Subpolar inferior hematoma; lesion
Contusion was interpreted and treatment was decided
No other organs were detected.
injured.
At 48 h, flank pain
right ventricular hypertrophy persisted intermittently, associated with
vomiting, a drop of 4 points
hematocrit, but without hemodynamic changes;
a urine analysis did not detect hematuria.
A transfusion with sedimented red blood cells was performed;
cefotaxime-metronidazole was indicated.
An ultrasound study reported mild hydronephrosis
It was decided to keep her under observation.
Ten days after admission, the girl presented
hyperthermia.
An ultrasound showed progression
perirenal collection, and axial tomography
abdominal computed tomography with intravenous contrast
a urinoma was diagnosed; percutaneous drainage was performed, achieving 785 cm of diameter.
24 h urine.
An ascending pyelography showed a laceration of the right pelvis.
As the urine output remained high despite
drainage, a ureteral double J stent was placed,
progressive reduction of urinoma.
Hospitalization
echography showed resolution of the urinoma five weeks later.
(reserve the tutor).
