Bilateral Ureteric Injurt: Its Presentation, Management and Outcomes: A Case Report

Abstract

Background:
Iatrogenic ureteric injury is a common complication of pelvic surgery especially Gynaecological procedures. However, bilateral ureteric injury is very rare with significant morbidity and occasional mortality. Total abdominal hysterectomy is responsible for most cases in our environment especially when performed by non specialist medical professionals. While literature is sparse on the presentation, management and outcomes of this rare condition, the few ones available do not give a clear guideline.
Case summary
A 48 year old woman with 2 days history of not passing urine through the urethral catheter following abdominal hysterectomy by a general practitioner. Indication for the surgery was a symptomatic fibroid. There was associated progressive abdominal distension. Significant findings on examination was non draining 18Fr foley”s urethral catheter, lower abdominal surgical wound, significant abdominal distension with vague tenderness. Serial electrolyte, urea and creatinine showed significant progressive deterioration of the renal functions. Ultrasound showed bilateral hydroureteronephrosis with significant intraperitoneal fluid collection.
Patient had emergency exploratory laparotomy with intra operative findings of 2.5L of intraperitoneal urine collection, dilated ureters, bilateral suture ligation of distal ureters with leakage of urine around suture lines. Patient had drainage of intraperitoneal collection, bilateral ureteroneocystostomy, bilateral ureteric stenting, peritoneal lavage and was placed on continuous Bladder drainage.