Complete ureteral necrosis after injury sustained during lumbar disc surgery: A case report

Abstract

Introduction: Reports pertaining to ureteral injury sustained during lumbar disc surgery are rare; most ureteral injuries in this setting involve laceration or transection.

Patient concerns: We report a rare case of a 55-year-old man who presented with complete left ureteral necrosis 20 days after sustaining ureteral transection during lumbar disc surgery.

Diagnosis: The patient presented with seroperitoneum caused by left ureteral injury; post-operative histopathological examination of surgical specimen after discectomy had revealed ureter-like tissue. Exploratory laparoscopic surgery revealed necrosis of a long segment of ureter, which was not amenable to treatment with conventional methods.

Intervention: We used a spiral bladder muscle flap with vascular pedicles to repair the ureteral defect.

Outcomes: Post-operative period was uneventful and the patient showed good recovery.

Conclusion: Spiral bladder muscle flap with vascular pedicles may be used to repair extensive ureteric injury.

Figure 1

CT angiogram showing thicker proximal ureter while the distal part is not discernible; the ureter cannot be traced distally in CT. Red arrow indicates the necrotic proximal ureter with edema.

Figure 2

Intraoperative (laparoscopic) photograph showing the torn mesentery and presence of urine in the peritoneal cavity.

Figure 3

(a) Intraoperative photograph showing the remanant left distal ureter (black arrow) only 5 cm to the bladder. (b) Intraoperative photograph showing the repaired ureteral defect (black arrow); a spiral bladder muscle flap with vascular pedicles was used.

Figure 4

Post-operative x-ray radiograph showing the normal position of the double J stent.

Figure 5

Post-operative intravenous urogram obtained at 5-month follow-up showing well-excreting left renal unit with good elimination of the contrast in postmicturation film. (a) 30 minutes after injection; (b) 60 minutes after injection.