Perirectal Urinoma From Ureteral Injury Incurred During Spinal Surgery Mimicking Rectal Perforation On Computed Tomography Scan

Gayer, Gabriela; Caspi, Israel; Garniek, Alexander; Hertz, Marjorie; Apter, Sara

doi:10.1097/00007632-200210150-00024

Cited by 24 publications

(9 citation statements)

References 8 publications

(20 reference statements)

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“…The paucity of early symptoms and signs in ureteral injury necessitates a high index of suspicion by the treating surgeon for prompt diagnosis and management 1 3. The duration until diagnosis, which is crucial for salvage of the involved renal unit, in most reported cases ranged from 3 days to 6 weeks after surgery 1 2 4. The first attempt to treat the ureteral injury should be ureteral stenting, retrograde or antegrade 5.…”

Section: Discussionmentioning

confidence: 99%

Ureteral injury after posterior lumbar discectomy with interbody screw fixation

et al. 2013

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SUMMARYWe report a case of iatrogenic ureteral injury secondary to L5 laminectomy and microdiscectomy with L5-S1 bone graft with posterior lumbar interbodyfusion using presacral cancellous screw fixation, managed by initial ureteral stent placement and subsequent Boari bladder flap repair. A 33-year-old woman underwent L5 laminectomy and microdiscectomy with L5-S1 bone graft with posterior lumbar interbody fusion using presacral cancellous screw fixation. On postoperative day 10, she developed lower abdominal pain, vomiting and fever. Ultrasonogram and contrast-enhanced CT demonstrated a large pelvic urinoma secondary to a right lower ureteric injury. This was managed initially by ureteral stent placement and subsequent Boari bladder flap repair. Ureteral injury following spinal surgery is a rare surgical complication with significant morbidity and mortality. A high index of suspicion is essential for early appropriate management and renal salvage. BACKGROUND

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Section: Discussionmentioning

confidence: 99%

Ureteral injury after posterior lumbar discectomy with interbody screw fixation

et al. 2013

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“…1 Only a few cases of ureteral injury during anterior lumbar approach have been reported; all were recognized after 48 hours and managed using endoscopic and percutaneous techniques. [6][7][8][9] Other predisposing factors for ureteral injury after lumbar disk surgery include thin patients, patients with defects in or absence of the anterior annulus, retroperitoneal scars or adhesions or accidental perforation of the anterior longitudinal ligament.…”

Section: Discussionmentioning

confidence: 99%

Hand-assisted laparoscopic ureteroureterostomy with renal mobilization for delayed recognition of a proximal ureteral injury after lumbar disk surgery

Kaffenberger

Tomaszewski

Tsao

et al. 2013

CUAJ

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We present hand-assisted laparoscopic ureteroureterostomy (HALUU) with renal mobilization as a novel approach to the management of proximal ureteral injury after lumbar disk surgery. A 63-year-old female underwent L4-L5 diskectomy and facetectomy with cage placement for back and leg pain. Postoperatively, she developed fever, nausea, abdominal pain, ileus and leukocytosis. A computed tomography scan of the abdomen and pelvis with intravenous contrast and delayed imaging demonstrated a left proximal ureteral injury with contrast extravasation. Retrograde and antegrade ureteral stent placement was unsuccessful; a nephrostomy tube was placed. Antegrade and retrograde ureterograms revealed a 3-cm proximal ureteral defect. All treatment options were discussed, and the patient chose to undergo hand-assisted laparoscopic renal mobilization with ureteroureterostomy, which was completed successfully without complications. Operative time was 381 minutes; estimated blood loss was 50 mL. The patient was discharged after 2 days, her ureteral stent was removed in 8 weeks, and follow-up with furosemide-mercaptoacetyltriglycine (MAG-3) renal scan demonstrated 30% function without evidence of obstruction. Hand-assisted laparoscopic ureteroureterostomy with renal mobilization can be performed as definitive management of a medium-length proximal ureteral injury. This is the first case describing this management technique after lumbar disk surgery.Can Urol Assoc J 2010;4(3):E82-E85

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“…Therefore, if data suggest that, with adequate training, spine surgeons may safely perform anterior spinal exposures in primary surgeries, provided vascular surgical assistance is readily available [25,26], we recommend caution when attempting anterior revision surgery, especially for exposures of L4-L5 or L5-S1 where vessel injuries are more frequent. Ureteral injuries have been reported in anterior lumbar spine surgery between 0.3 and 0.5 % of the cases, and in isolated cases occurring mainly during revision procedures [3,[7][8][9][10][11]. During anterior exposure, the ureter must be carefully identified to prevent iatrogenic injury.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of vascular injury is estimated at 1.9-8 %, with the greatest risk at the L4-L5 level [3][4][5]. Ureteral injury during anterior lumbar arthrodesis has been reported in only a small number of cases [3,[5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Analysis of intraoperative difficulties and management of operative complications in revision anterior exposure of the lumbar spine: a report of 25 consecutive cases

et al. 2012

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Purpose After a first anterior approach to the lumbar spine, formation of adhesions of soft tissues to the spine increases the surgical difficulties and potential for iatrogenic injury during the revision exposure. The objective of this study was to identify the intraoperative difficulties and postoperative complications associated with revision anterior lumbar spine procedures in a single institution. Methods This is a retrospective review of 25 consecutive anterior revision lumbar surgeries in 22 patients (7 men and 15 women) operated on between 1998 and 2011. Patients with trauma or malignancies were excluded. The mean age of the patients at the time of revision surgery was 56 years (range 20-80 years). The complications were analyzed depending on the operative level and the time between the index surgery and the revision. Results Six major complications (five intraoperatively and one postoperatively) occurred in five patients (20 %): three vein lacerations (12 %) and two ureteral injuries (8 %), despite the presence of a double-J ureteral stent. The three vein damages were repaired or ligated by a vascular surgeon. One of the two ureteral injuries led to a secondary nephrectomy after end-to-end anastomosis failure; the other necessitated secondary laparotomy for small bowel obstruction. Conclusions Anterior revision of the lumbar spine is technically challenging and is associated with a high rate of vascular or urologic complications. Therefore, the potential complications of the procedure must be weighted against its benefits. When iterative anterior lumbar approach is mandatory, exposure should be performed by an access surgeon in specialized centers that have ready access to vascular and urologic surgeons.

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Perirectal Urinoma From Ureteral Injury Incurred During Spinal Surgery Mimicking Rectal Perforation On Computed Tomography Scan

Cited by 24 publications

References 8 publications

Ureteral injury after posterior lumbar discectomy with interbody screw fixation

Ureteral injury after posterior lumbar discectomy with interbody screw fixation

Hand-assisted laparoscopic ureteroureterostomy with renal mobilization for delayed recognition of a proximal ureteral injury after lumbar disk surgery

Analysis of intraoperative difficulties and management of operative complications in revision anterior exposure of the lumbar spine: a report of 25 consecutive cases

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