Downloaded from http://emj.bmj.com/ on April 13, 2015 - Published by group.bmj.com
Original article
IMAGES IN EMERGENCY MEDICINE
Complete urethral transection A 62-year-old carpenter presented to the emergency department with perineal pain, after falling from a height of 5 m and hitting his buttocks against the ground. Physical examination revealed ecchymosis around the perineum and scrotum (figure 1), and gross blood at the urethral meatus. Contrast-enhanced CT showed gluteal haematoma and a linearly enhancing lesion in the corpus spongiosum (figure 2), suggesting arteriovenous fistula. Retrograde urethrography revealed massive extravasation of contrast medium at the junction of the bulbar and penile urethra (figure 3), indicating complete urethral transection. Urethral injury is a common complication of pelvic trauma. Signs suggestive of urethral injury include blood at the meatus, swelling or ecchymosis of the perineum or scrotum, blood in the scrotum, or presence of a high-riding or non-palpable prostate. Retrograde urethrography shows contrast medium extravasation if urethral injury is present.1 Urethral injuries are rarely life-threatening in the acute phase; however, they may lead to long-term morbidity, including urethral stricture, incontinence and impotence, resulting in lower quality of life.2 Management during the acute phase is
Figure 3 Massive extravasation of contrast medium at the junction of the bulbar and penile urethra. controversial, comprising either suprapubic cystostomy and interval urethroplasty some months later, or realignment of the urethra.3 This patient underwent suprapubic cystostomy immediately, and interval urethroplasty 6 months later. Hayaki Uchino,1 Akira Kuriyama,2 Ryosuke Echigoya1 1
Department of Emergency Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan 2 Department of General Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan Correspondence to Dr Akira Kuriyama, Department of General Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan; [email protected] Contribution HU, AK and RE looked after the patient, wrote the manuscript and approved its submission. The authors wish to thank Ms Ryoko Ono for editing the figures. Conflicts of interests None. Patient consent Obtained. Provenance and peer review Not commissioned; externally peer reviewed.
Figure 1 Ecchymosis around the perineum and scrotum.
To cite Uchino H, Kuriyama A, Echigoya R. Emerg Med J 2015;32:8. Accepted 7 February 2014 Published Online First 27 February 2014 Emerg Med J 2015;32:8. doi:10.1136/emermed-2013-203551
REFERENCES 1 2
Figure 2 A linearly enhancing lesion in the corpus spongiosum. 8
3
Ingram MD, Watson SG, Skippage PL, et al. Urethral injuries after pelvic trauma: evaluation with urethrography. Radiographics 2008;28:1631–43. Ziran BH, Chamberlin E, Shuler FD, et al. Delays and difficulties in the diagnosis of lower urologic injuries in the context of pelvic fractures. J Trauma 2005;58:533–7. Gómez RG, Mundy T, Dubey D, et al. Chapter 7: Pelvic Fracture Urethral Injuries. Urology Published Online First: 7 Nov 2013. doi:10.1016/j.urology.2013.09.023
Kline JA, et al. Emerg Med J 2015;32:3–8. doi:10.1136/emermed-2014-203602
Downloaded from http://emj.bmj.com/ on April 13, 2015 - Published by group.bmj.com
Complete urethral transection Hayaki Uchino, Akira Kuriyama and Ryosuke Echigoya Emerg Med J 2015 32: 8 originally published online February 27, 2014
doi: 10.1136/emermed-2013-203551 Updated information and services can be found at: http://emj.bmj.com/content/32/1/8
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Articles on similar topics can be found in the following collections Clinical diagnostic tests (989) Pain (neurology) (946) Radiology (939) Radiology (diagnostics) (846)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Original article
IMAGES IN EMERGENCY MEDICINE
Complete urethral transection A 62-year-old carpenter presented to the emergency department with perineal pain, after falling from a height of 5 m and hitting his buttocks against the ground. Physical examination revealed ecchymosis around the perineum and scrotum (figure 1), and gross blood at the urethral meatus. Contrast-enhanced CT showed gluteal haematoma and a linearly enhancing lesion in the corpus spongiosum (figure 2), suggesting arteriovenous fistula. Retrograde urethrography revealed massive extravasation of contrast medium at the junction of the bulbar and penile urethra (figure 3), indicating complete urethral transection. Urethral injury is a common complication of pelvic trauma. Signs suggestive of urethral injury include blood at the meatus, swelling or ecchymosis of the perineum or scrotum, blood in the scrotum, or presence of a high-riding or non-palpable prostate. Retrograde urethrography shows contrast medium extravasation if urethral injury is present.1 Urethral injuries are rarely life-threatening in the acute phase; however, they may lead to long-term morbidity, including urethral stricture, incontinence and impotence, resulting in lower quality of life.2 Management during the acute phase is
Figure 3 Massive extravasation of contrast medium at the junction of the bulbar and penile urethra. controversial, comprising either suprapubic cystostomy and interval urethroplasty some months later, or realignment of the urethra.3 This patient underwent suprapubic cystostomy immediately, and interval urethroplasty 6 months later. Hayaki Uchino,1 Akira Kuriyama,2 Ryosuke Echigoya1 1
Department of Emergency Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan 2 Department of General Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan Correspondence to Dr Akira Kuriyama, Department of General Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan; [email protected] Contribution HU, AK and RE looked after the patient, wrote the manuscript and approved its submission. The authors wish to thank Ms Ryoko Ono for editing the figures. Conflicts of interests None. Patient consent Obtained. Provenance and peer review Not commissioned; externally peer reviewed.
Figure 1 Ecchymosis around the perineum and scrotum.
To cite Uchino H, Kuriyama A, Echigoya R. Emerg Med J 2015;32:8. Accepted 7 February 2014 Published Online First 27 February 2014 Emerg Med J 2015;32:8. doi:10.1136/emermed-2013-203551
REFERENCES 1 2
Figure 2 A linearly enhancing lesion in the corpus spongiosum. 8
3
Ingram MD, Watson SG, Skippage PL, et al. Urethral injuries after pelvic trauma: evaluation with urethrography. Radiographics 2008;28:1631–43. Ziran BH, Chamberlin E, Shuler FD, et al. Delays and difficulties in the diagnosis of lower urologic injuries in the context of pelvic fractures. J Trauma 2005;58:533–7. Gómez RG, Mundy T, Dubey D, et al. Chapter 7: Pelvic Fracture Urethral Injuries. Urology Published Online First: 7 Nov 2013. doi:10.1016/j.urology.2013.09.023
Kline JA, et al. Emerg Med J 2015;32:3–8. doi:10.1136/emermed-2014-203602
Downloaded from http://emj.bmj.com/ on April 13, 2015 - Published by group.bmj.com
Complete urethral transection Hayaki Uchino, Akira Kuriyama and Ryosuke Echigoya Emerg Med J 2015 32: 8 originally published online February 27, 2014
doi: 10.1136/emermed-2013-203551 Updated information and services can be found at: http://emj.bmj.com/content/32/1/8
These include:
References Email alerting service
Topic Collections
This article cites 2 articles, 0 of which you can access for free at: http://emj.bmj.com/content/32/1/8#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Clinical diagnostic tests (989) Pain (neurology) (946) Radiology (939) Radiology (diagnostics) (846)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
