Ureteral transection due to intraperitoneal course of ureter after pediatric ureteral reimplantation.

Abstract

Traditional pediatric ureteral reimplantation involved blindly passing a clamp behind the bladder to guide the ureter into a new hiatal opening, potentially resulting in an intraperitoneal ureter. A 44-year-old woman with previous ureteral reimplantation underwent gynecologic laparoscopy. Two fibrous bands attached a segment of small bowel to the abdominal wall. One band was transected and ligated. Postoperative suspicion that the bands represented ureter prompted computed tomography imaging, showing high-grade ureteral obstruction. Retrograde pyelogram revealed urinary extravasation and no continuity with the ureter. Reoperation with ureteroneocystotomy confirmed the bands were ureter coursing through bowel, consistent with injury during ureteral reimplantation. Review of previous surgeries, a high index of suspicion, and prompt urologic consultation are recommended to identify and repair ureter injuries in abnormal anatomy cases.