Figure 8e. Ureteral urine leak and urinoma in a 73-year-old man who presented with abdominal pain 2 weeks after undergoing low anterior resection. (a) CT scan demonstrates an extensive intraperitoneal fluid collection in the left side of the pelvis. The fluid collection extended superiorly into the lesser sac (not shown). Because of the extensive nature of the collection, a percutaneous drainage catheter was placed under US guidance. (b) Sagittal US image demonstrates the percutaneous drainage catheter (arrow), which has been advanced into the complicated intraperitoneal fluid collection. The collection completely collapsed following drainage despite the appearance of multiple septa within the collection (arrowheads). (c) Intravenous pyelogram obtained 3 days after b and 10 minutes after contrast material injection demonstrates persistent extravasation of contrast material in the left side of the pelvis (arrow), a finding that helped confirm the diagnosis of urinoma. A left percutaneous nephrostomy catheter (not shown) was placed. (d) Antegrade pyelogram obtained following left percutaneous nephrostomy demonstrates a distal contrast material leak (arrow). Despite combination treatment with percutaneous nephrostomy and a urinoma drainage catheter (arrowheads), outputs from the latter remained high. Neither antegrade nor retrograde ureteral stent placement was successful. The urologist wanted to defer definitive surgical treatment for 3-6 months due to a perioperative myocardial infarction. Ureteral embolization was offered as a temporizing measure to divert urine flow from the ureteral leak. (e) Antegrade pyelogram demonstrates two Gianturco coils (arrowheads) in the distalmost portion of the left ureter above the transection. Contrast material from prior injections is seen inferiorly (arrow). (f) CT scan obtained 2 weeks after e demonstrates an interval decrease in the size of the pelvic urinoma due to urinary diversion from the site of the ureteral leak.