A 44 yo M with a remote history of testicular cancer and recent retroperitoneal lymph node resection presents with sharp R sided abdominal pain. He has associated nausea, vomiting, constipation and decreased appetite. His VS are normal and his abdomen is nontender on exam. A CT abdomen/pelvis is obtained. What's the diagnosis? (scroll down for answer)

Answer: Urinoma, likely secondary to iatrogenic urethral injury

• Ureteral injuries (though rare) are most commonly iatrogenic or secondary to penetrating trauma
• Patients can present with fever, flank pain, sepsis, or symptoms mimicking ileus, as seen in this case
• Diagnosis typically made with CT abdomen/pelvis w/ IV contrast with delayed phase
• Extravasation of contrast along the course of the ureter is diagnostic for ureteral injury 
• Complications include periureteral abscess, peritonitis, urethral stricture and urinary fistula
• Small ureteral injuries may be amenable to stenting, while urinoma may be drained by IR
• More extensive ureteral injuries may require ligation with delayed surgical repair

References: Gratton MC, French L. Gratton M.C., French L Gratton, Matthew C., and L. Keith French.Genitourinary Trauma. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. Tintinalli J.E., Stapczynski J, Ma O, Yealy D.M., Meckler G.D., Cline D.M. Eds. Judith E. Tintinalli, et al.eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e New York, NY: McGraw-Hill; 2016.