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Ureteral Transection Due to Intraperitoneal Course of Ureter After Pediatric Ureteral Reimplantation

Ritch, Jessica M.B. MD; Heidemann, Nicole L. MD

doi: 10.1097/AOG.0b013e3182a9cab6
Case Report

BACKGROUND: 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.

CASE: 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.

CONCLUSION: 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.

Pediatric ureteral reimplantation rarely results in an intraperitoneal ureter coursing directly through the small bowel, which is identified after transection and ligation of the ureter.

Baptist Hospital, Nashville, Tennessee.

Corresponding author: Jessica M.B. Ritch, Center for Pelvic Health, 4601 Carothers Parkway, Suite 350, Franklin, TN 37067; e-mail: ritch.jessica@gmail.com.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists.