Ureteral Dissection Is a Risky Factor for Ureteral Rupture, the First Case Report.

Backgroundureteral dissection（UD）is a rare condition which occurs when injury through the intima and occasionally the media allows entry of urine and separation of the inner and outer ureteral layers. Ureteral rupture (UR) is an urgent disease when ureter wall injures through entire layers, generally caused by ureteral calculus, frequent application of ureteral endoscope, trauma, oppression of tumors, iatrogenic injury and with urine flowing into peripheral space easily causes peritonitis, so patients usually present features of peritonitis prior to signs of urinary tract. Ureteral dissection found in ureteral rupture is the first report. Case presentation21-year-old male and 43-year-old female complained of left and right lumbago respectively with no obvious predisposing cause. Bilateral ureter dilation and contrast agent extravasation observed in imageological examination was the same point between the two patients. Delayed computed tomography (CT) and retrograde pyelography both show double lumen sign and damaged intima. All imaging results throw light on the nature of this disease, like formation of aortic dissection (AD). ConclusionThe emphasis of this study lies in imaging manifestations of UD to enable radiologist to find it accurately and rapidly, and also demonstrates that delayed CT and retrograde pyelography can effectively diagnose ureteral dissection with very high accuracy.

Ureteral Dissection is a Transient Process Before Ureteral Rupture: A Case Report

Background: Ureteral dissection（UD）is a rare condition which occurs when injury through the intima and occasionally the media allows entry of urine and separation of the inner and medial ureteral layer just like the formation of aortic dissection. Ureteral rupture (UR) is generally caused by ureteral calculus, operation of ureteral endoscope, trauma, tumors, iatrogenic injury and easy to cause peritonitis, so patients usually show symptoms of peritonitis prior to signs of urinary tract. Ureteral rupture caused by ureteral dissection is rarely reported. Case presentation:21-year-old male and 43-year-old female were both admitted into hospital because of abdominal pain. Enhanced CT and retrograde pyelography showed “double lumen sign” in the right proximal ureter and contrast extravasation in the perinephric gap. The male is dead due to serious condition but the female is in good condition without complication after correct and timely therapy. Conclusions: UD is a transient process viewed by enhanced CT or retrograde pyelography offering a warning sign of UR in order to improve prognosis.