Ureteral Contusion with Gunshot Wounds

The entity of ureteral contusion with a gunshot wound has not been well described in the literature. The blast effect of the bullet, even one of low velocity, can cause contusion of the ureter manifested by hematuria, no extravasation on the IVP, and a normal appearing ureter or some bruising of the ureteral wall and periureteral tissues. The ureteral contusion may resolve or may progress to delayed necrosis of the ureteral wall with urine leakage. Twelve cases of ureteral contusion with gunshot wounds are reported. The ureter was found contused at exploration in two patients; one had excision of the contused area with end-to-end anastomosis and the other had a nephrostomy and ureteral splint. The ureter appeared normal in ten patients and no immediate treatment was performed to the ureter; eight had no postoperative evidence of urine leakage and two developed a urinary fistula.