Ureteral Peritonitis after an Abdominal Aortic Aneurysm Repair

Shinichi Nata＊	Kentaro Sawada＊	Takanori Kono＊
Yusuke Shintani＊	Hiroyuki Ohtsuka＊	Shinichi Hiromatsu＊
Hiroyuki Tanaka＊

（Department of Surgery, Kurume Medical University＊, Kurume, Japan）

An 84-year-old man electively underwent abdominal aortic open repair for an abdominal aortic aneurysm. During the operation, the ureter was not confirmed when manipulating the iliac arteries. Subsequently, intestinal paralysis occurred on the fifth day after surgery and a drainage tube of the intestinal tract was inserted. Liquid retention around the left iliopsoas muscle, and left renal nephropathy were recognized on performing enhanced computed tomography（CT）on postoperative day 11. An initial diagnosis of an iliopsoas abscess was considered. Simple CT imaging was performed on the 13th day after surgery without symptomatic improvement. This scan revealed that the contrast agent had remained in the cavity since the previous CT scan, which had been misdiagnosed as an abscess. Ureteral injury was now suspected. Retrograde ureterography revealed an urinoma caused by left ureter injury. We diagnosed paralytic ileus due to urinoma. For drainage of the urine, a percutaneous renal fistula was constructed. He was discharged from the hospital on the 56th postoperative day, and by six months after the operation, the urinary tract problem had disappeared. In conclusion, we report a case of delayed ureteral injury that occurred after abdominal aortic open repair surgery.

 

Jpn. J. Cardiovasc. Surg. 48:152-156（2019）

Keywords：abdominal aortic aneurysm;surgical complication;ureteral injury;urinoma