British Journal of Urology (1975), 41, 362 0
Short Case Report
Post-traumatic Haemoglobinuria A 25-year-old woman sustained a left back injury in an automobile accident. Despite back pain, she did not seek medical attention until 9 days after injury, when she noted "black" urine. Urinalysis showed no red blood cells but was strongly positive for haemoglobin. Urograms showed extravasation from a middle calyx (Fig. I, A). Her gross haernoglobinuria persisted for a few days and then ceased. Urogram 8 days later was normal (Fig. 1, B).
Delayed haematuria has been seen 24 to 72 hours after renal cortical injury as a result of either delayed seepage of blood into the tubules or dislodgement of a calyceal clot (Mitchell, 1967). The injury in the present case was most likely a contained cortical haematoma and occurred in close proximity to a middle fornix. A rupture through the fornix 9 days later probably was secondary to increased pressure within the haematoma from red blood cell lysis and breakdown products of haemoglobin, as occurs with subdural haematomas (Collins et al., 1969), and would explain the haemoglobinuria. JAMES E. GO-ITESMAN and JAMES R. ORECKLIN From the Department of Surgery, Division of Urology, UCLA School of Medicine, b s Angeles, California, and Wadsworth Veterans Administration Hospital, Los Angeles, Cal(fornia
References COLLINS, W.F., GALICICH, J. H. and MAHNKE, J. H. (1969). Principles of Surgery. New York: McGraw-Hill p. 1495. MITCHELL, J. P. (1967). Injuries to the upper urinary tract. Postgraduate Medical Journal, 43,415.
Fig. 1
362
Short Case Report
Post-traumatic Haemoglobinuria A 25-year-old woman sustained a left back injury in an automobile accident. Despite back pain, she did not seek medical attention until 9 days after injury, when she noted "black" urine. Urinalysis showed no red blood cells but was strongly positive for haemoglobin. Urograms showed extravasation from a middle calyx (Fig. I, A). Her gross haernoglobinuria persisted for a few days and then ceased. Urogram 8 days later was normal (Fig. 1, B).
Delayed haematuria has been seen 24 to 72 hours after renal cortical injury as a result of either delayed seepage of blood into the tubules or dislodgement of a calyceal clot (Mitchell, 1967). The injury in the present case was most likely a contained cortical haematoma and occurred in close proximity to a middle fornix. A rupture through the fornix 9 days later probably was secondary to increased pressure within the haematoma from red blood cell lysis and breakdown products of haemoglobin, as occurs with subdural haematomas (Collins et al., 1969), and would explain the haemoglobinuria. JAMES E. GO-ITESMAN and JAMES R. ORECKLIN From the Department of Surgery, Division of Urology, UCLA School of Medicine, b s Angeles, California, and Wadsworth Veterans Administration Hospital, Los Angeles, Cal(fornia
References COLLINS, W.F., GALICICH, J. H. and MAHNKE, J. H. (1969). Principles of Surgery. New York: McGraw-Hill p. 1495. MITCHELL, J. P. (1967). Injuries to the upper urinary tract. Postgraduate Medical Journal, 43,415.
Fig. 1
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