Uretero-aortic fistula: a case report

Abstract

We report a case of uretero-aortic fistula following prolonged ureteral stenting in the left ureter which crossed over the aorta toward the cutaneous ureterostomy stoma. A 59 year-old woman presented massive bleeding from the left cutaneous ureterostomy of the single stoma for bilateral ureters. The patient underwent radical hysterectomy and total cystectomy with a single stoma cutaneous ureterostomy for advanced cervical and bladder cancers. The postoperative course was uneventful except for pyelonephritis due to bilateral ureteral stenosis, which were treated by bilateral ureteral stenting. The patient had intermittent hematuria from the left cutaneous ureterostomy for 4 years after ureteral stenting. Massive bleeding from the left cutaneous ureterostomy requiring a big amount of blood transfusion followed intermittent hematuria, finally. A Computed tomography (CT) suggested both severe adhesion of the left ureter to the aorta and left renal pelvic hematoma. Massive bleeding seemed to be caused by uretero-aortic fistula. A fistula, about 5 mm in diameter, from the left ureter to the aorta was detected at exploration. The defect of aortic wall was closed primarily and then left nephroureterectomy underwent for nonfunctioning kidney. Her postoperative course was uneventful at the 18-month follow-up.