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CASE REPORT
Year : 2020  |  Volume : 9  |  Issue : 3  |  Page : 166-169

Renal calyceal rupture following ureteral injury after total laparoscopic hysterectomy


1 Department of Gynecology and Obstetrics, St. Josefskrankenhaus, Teaching Hospital of the University of Freiburg, Freiburg, Germany
2 Radiology and Interventional Radiology, St. Josefskrankenhaus, Teaching Hospital of the University of Freiburg, Freiburg, Germany

Correspondence Address:
Dr. Rafł Watrowski
Department of Gynecology and Obstetrics, St. Josefskrankenhaus, Teaching Hospital of the University of Freiburg, Freiburg
Germany
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/GMIT.GMIT_28_19

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Ureteral injury (UI) complicates 0.1%–2.5% of total laparoscopic hysterectomies (TLHs). Renal calyceal rupture (RCR) is predominantly seen in patients with ureteral stones causing ureteral obstruction. Iatrogenic (surgical and nonsurgical) causes are responsible for only 3.5% of RCR. A 45-year-old gravida 4, para 2 female with a body mass index of 20 and no previous abdominal surgeries underwent a TLH due to hypermenorrhea and secondary anemia in the presence of a myomatous uterus. Intraoperatively, pelvic endometriosis and an isthmic myoma, 4 cm in diameter, were documented. On the 2nd postoperative day, the patient reported right-sided loin pain. The computed tomography scan revealed a right-sided RCR with urine extravasation and a retroperitoneal and intra-abdominal urinoma. The patient was treated with a transitory nephrostomy for 6 months, and subsequently finally with ureteroneocystostomy (psoas hitch). This case extends the spectrum of iatrogenic RCR causes as well as UI manifestations after TLH.


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