Spontaneous Healing Of Iatrogenic Complete Ureteric Transection Injury
Sayedin, H., & Al-Machhour, M. (2021). Spontaneous Healing of Iatrogenic Complete Ureteric Transection Injury. Cureus, 13(11), e19440. https://doi.org/10.7759/cureus.19440
View Original Source →Abstract
Iatrogenic ureteric injury is the most common cause of ureteric injury. It is usually caused by either gynecological or urological surgical procedures. Iatrogenic ureteric injury repair depends mainly on the time of diagnosis. We represent here a case of iatrogenic complete transection ureteric injury resulted from laparoscopic bilateral salpingo-oophorectomy. The patient had a history of abdominal hysterectomy causing adhesions that resulted in challenging surgery. One week later, the patient presented to the emergency department with abdominal pain, and contrast CT showed left hydronephrosis with extravasation of the contrast at the left renal pelvis. The patient was treated initially with left nephrostomy and an antegrade nephrostogram confirmed the diagnosis of complete transection ureteric injury. Surprisingly, left retrograde study, which was done 11 weeks after the operative injury, showed healing of the ureteric injury with a small annular stricture. The stricture was dilated and a stent was inserted. We concluded that conservative waiting and delayed ureteric repair might be advised in similar injuries allowing time for resolution of the postoperative inflammatory reaction and spontaneous healing.
Case Details
Disease Location
Ureter
Personal Characteristics
56-year-old woman, history of total abdominal hysterectomy 20 years prior for endometriosis
Clinical Characteristics
Underwent laparoscopic bilateral salpingo-oophorectomy. Adhesions were obscuring the anatomy of the left ureter during surgery. In the early postoperative days, there was mild pain at the left iliac fossa and was managed with paracetamol and oral morphine. One week later, the patient presented to the emergency department with severe left iliac fossa pain associated with nausea and vomiting. Diagnosis of left ureteric iatrogenic injury was concluded. Managed initially with urgent CT-guided nephrostomy insertion. Three weeks post-traumatic injury, the patient underwent antegrade nephrostogram. It showed complete transection of the ureter. The patient was planned for reconstructive surgery.
Remission Characteristics
Prior to the surgery, left retrograde study was performed. The contrast went up to the left kidney with only annular stricture at the level of the injury
Treatment & Mechanisms
Proposed Remission Mechanisms
The ureter might spontaneously heal by stricture after urinary diversion by nephrostomy tube
Clinical Treatment
Paracetamol, oral morhpine, nephrostomy.
Non-Clinical Treatment
None reported