Abstract: FR-PO742
Unrecognized Ureteral Injury After Attempted Hysterectomy in Transplant Patients
Session Information
- Post-Transplantation and Case Reports
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Anwar, Amber, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Shawar, Saed, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Eid, Kareem, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Introduction
Although frequently overlooked, ureteral injuries are well-documented complications following gynecologic surgeries, potentially causing acute kidney injury and failure. To mitigate these undesirable outcomes, involvement of a multidisciplinary team, including transplant surgeons, is highly recommended in complex patients. We present a unique case of a simultaneous pancreas-kidney transplant patient with an unrecognized ureteral during an attempted hysterectomy.
Case Description
A 42-year-old woman with End-Stage Renal Disease due to Type 1 Diabetes Mellitus and status post simultaneous kidney and pancreas transplant in 05/2021. Induced with Alemtuzumab and Solumedrol and maintained on Tacrolimus, Mycophenolate Mofetil, and Prednisone, with creatinine range 0.8-1mg/dl, alongside normal amylase and lipase levels.
In 07/2022, the patient attempted a laparoscopic hysterectomy at a local hospital for unresolved menorrhagia. However, the surgery was abandoned due to extensive intraabdominal adhesions, with partial adhesiolysis performed before closure. Following discharge on the same day, she presented with acute abdominal pain, anuria and rise in creatinine 11mg/dl from 0.93mg/dl. CT scan revealed an edematous transplant kidney with hydroureteronephrosis and intra-abdominal and pelvic ascites. The Transferred to Vanderbilt University Medical Center, where ultrasound confirmed hydroureteronephrosis and a discontinuity of the ureter with the bladder. In addition, CT cystogram showed lack of opacification of the reimplanted ureter, concerning for ureteral injury. An urgent laparotomy was performed by a multidisciplinary team of urologists and renal transplant surgeons, resulting in drainage of three liters of urine from the abdominal cavity and the identification of a transected ureter above the urinary bladder. Assisted cystourethroscopy was utilized to repair and reimplant the ureter to the urinary bladder, resulting in the resumption of urine output and a rapid decrease in creatinine levels to baseline.
Discussion
For complex intra-abdominal or pelvic surgeries, involvement of transplant surgeons is paramount. Negligence can lead to significant postoperative complications, such as acute kidney injury, increasing morbidity and mortality. Prompt interventions, like ureteral repair and reimplantation conducted in this case, can lead to a remarkable recovery from severe complications.