Iatrogenic Ureteral and Colonic Injuries During Emergency Cesarean Section: A Lesson Learned from a Surgical Catastrophe – A Case Report

Abstract

Introduction

Iatrogenic concomitant ureteral and colonic injury in emergency cesarean section (C-section) is an exceedingly rare, yet, catastrophic complication and has not been reported to our knowledge.

Case Report

A 30-year-old woman presented with decreased urination for 2 days after a C-section. Ultrasonography showed severe left hydronephrosis and moderate abdominal free fluid. A ureteroscopy revealed a total occlusion of the left ureter, and subsequently, a ureteroneocystostomy was performed. Two days later, the patient was complicated with abdominal distension that necessitated re-exploration. The exploration revealed colonic injury (rectosigmoid), peritonitis, endometritis, and ureteral anastomosis disruption. A colostomy, repair of colonic injury, hysterectomy, and ureterocutaneous diversion were performed. The patient’s hospital stay was complicated, with stomal retraction requiring operative revision and wound dehiscence, which was treated conservatively. After 6 months, the colostomy was closed, and the ureter was anastomosed via the Boari-flap procedure.

Conclusion

Injuries to the urinary and gastrointestinal tracts are serious complications of a cesarean section; concurrent involvement is exceedingly rare; however, delayed recognition and intervention can worsen the prognosis.

Keywords:

• case report
• cesarean section
• colon injury
• iatrogenic
• ureteral injury

Consent

Written informed consent was obtained from the patient to publish this case report and any accompanying images. No institutional approval was required to publish the case report.

Acknowledgment

The authors would like to thank the General Manager of Althora General Hospital, Ibb, Yemen, Dr Abdulghani Ghabisha, for editorial assistance.

Disclosure

The authors declare that they have no conflicts of interest in this work.