V01-06 Bowel Obstruction After Complex Fistula Repair: Case Presentation and Review of the Literature

You have accessJournal of UrologyUpper Tract Reconstruction (V01)1 May 2024V01-06 BOWEL OBSTRUCTION AFTER COMPLEX FISTULA REPAIR: CASE PRESENTATION AND REVIEW OF THE LITERATURE Joanna Marantidis, Abigail Davenport, Deirdre Dulak, Preetha Ali, and Lee A. Richter Joanna MarantidisJoanna Marantidis , Abigail DavenportAbigail Davenport , Deirdre DulakDeirdre Dulak , Preetha AliPreetha Ali , and Lee A. RichterLee A. Richter View All Author Informationhttps://doi.org/10.1097/01.JU.0001008884.22400.05.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Retroureteral hernias are a rare post-operative complication. We present a case of a 35 year-old woman who underwent emergent cesarian section, which was complicated by a bladder and ureteral injury resulting in a vesicovaginal fistula. She underwent fistula repair and reimplantation of her ureter, but presented nearly two years later with a bowel obstruction from a retroureteral hernia. In this video, we review the literature and illustrate an operative technique in managing this complication. METHODS: Given the concern for bowel obstruction, the patient was taken to the operative room for diagnostic laparoscopy. Upon entering the abdomen, the patient's right ureter was tented up at the anastomosis and was intraperitoneal along its distal half . As a result, the ureter acted as a band, around which we found the cecum, ascending colon, appendix, and terminal ileum and several loops of small bowel, forming an internal hernia. We carefully reduce the bowel loops and restored normal anatomy. We then proceeded to retroperitonealize the ureter to prevent recurrence of the internal hernia. The peritoneum overlying the sacral promontory and near the ureter where it coursed over the right pelvic brim was sharply incised and the incision carried down the right paracolic gutter to the level of the vagina, similar to the dissection performed in a laparoscopic sacrocolpopexy. The ureter was then covered by the freed peritoneum with interrupted 2-0 vicryl sutures, thus re-retroperitonealizing it. Additional interrupted sutures closed the peritoneum of the right paracolic gutter and right cul-de-sac which eliminated any potential spaces where bowel could become entrapped in the future. RESULTS: Postoperatively, the patient had complete resolution of her abdominal and flank pain. Imaging with antegrade nephrostogram, and later with MAG3 scan demonstrated no evidence of ureteral obstruction. There have only been 10 reported cases of retro-ureteral hernias – 4 after radical hysterectomy, 3 after cystectomy and ileal conduit and 3 after ureteral reimplantation. Presentation ranged between 12 days and 20 years and some cases required reimplantation of the ureter. CONCLUSIONS: We present a rare case of ureteral and intestinal obstruction after complex fistula repair and ureteral reimplant. This video presents a useful technique demonstrating how to retroperitonealize the reimplanted ureter, to preserve the reimplant and resolve this complication. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e97 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Joanna Marantidis More articles by this author Abigail Davenport More articles by this author Deirdre Dulak More articles by this author Preetha Ali More articles by this author Lee A. Richter More articles by this author Expand All Advertisement PDF downloadLoading ...