Iatrogenic Complication of Colorectal Surgery: Bilateral Lesion of the Ureters with Consequent Obstructive Nephropathy

Abstract Introduction. In colorectal surgery iatrogenic ureteral injuries are possible, but in small percentage. Although rare, bilateral ureteral injuries are recognized early due to the development of clinical presentation of obstructive nephropathy. Radiodiagnostic procedures determine location of ureteral injuries but for solving the dilemma the most precise is the intraoperative exploration, which is presented in our case. Case report. We present a patient who underwent surgery due to colorectal cancer. Postoperatively the patient was aenuric, with increase of the degradation products and need of hemodialysis on the second day of hospitalization. The CT of abdomen showed hydronephrotically changed kidneys. An attempt to place a J-J stent was made, but it was unsuccessful. MRI urography revealed hydronephrotically changed kidneys, but with interruption in continuity of both ureters. An abdominal surgeon and an urologist were consulted and revision was made because of ureteral obstruction and an iatrogenic occlusion of both ureters. The condition was surgically resolved. In the postoperative period the patient was with normal diuresis and no need of hemodyalis. Conclusions. Iatrogenic injury of the ureters after resection of the rectum is a possible consequence, which is presented with signs of obstructive nephropathy in the early postoperative period. Routine diagnostic procedures do not always help to establish a relevant diagnosis. Therefore, surgery might have a double role, both diagnostic and therapeutic, but prevention is needed by placing stents in ureters and urinary catheter in the preoperative period.