Fig. 12

Ureteral injury manifesting with fever and pelvic tenderness 3 days after TLH. Vaginal examination and sonography (not shown) detected a sizeable hypo-anechoic pelvic collection, initially interpreted as a vaginal vault haematoma, which rapidly increased in volume. CT confirmed a large fluid-attenuation collection (*) cranial to the urinary bladder and vagina, which in the excretory phase (B, C) was partially opacified by enhanced urine (arrowhead in B) leaking from the right ureter. The latter was opacified (arrow in C) distally to the injury, consistent with an incomplete laceration. Note surgical clips (thin arrows). Conservative treatment included ureteral stenting and prolonged catheterisation. A month later, follow-up CT (not shown) showed near-complete resolution of the urinoma (Partially reproduced with permission from ref. no [61])