You are asked by the Gynaecology SPR to see a patient who had an abdominal hysterectomy 48 hours ago. The patient is tachycardic, pyrexial (39.2) and complaining of left flank pain. There is abdominal and left flank tenderness, and drainage of 500 mL of blood stained fluid in the last 12 hours from the pelvic drain. FBC – Hb 10.2, WCC 15.0. Electrolytes are normal. The next step in management is to:a. Arrange urgent exploratory laparotomy and repair of suspected ureteric injury
This patient has a urological injury until proven otherwise. It is essential to determine what injuries exist – right or left ureter, bladder or a combination. Contrast imaging is essential followed by nephrostomy in this sick patient. Once the patient is better, reconstruction can be considered.