Ileal Ureter Replacement for Radiation-induced Long-segment Ureteral Stricture in a Patient with Prior Abdominoperineal Resection and Colostomy.
Maham Ahmad, Suraj Bhondave
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Case in brief
A 56-year-old woman previously treated for anal canal carcinoma with abdominoperineal resection, colostomy, chemotherapy, and radiotherapy developed bilateral ureteric obstruction and a small-capacity bladder. Right ureteral stenting was feasible, but left-sided stenting failed, necessitating percutaneous nephrostomy. At surgery, long-segment left ureteral obliteration was found amid dense pelvic fibrosis, adhesions, and prior surgical scarring. After endourological management of the right ureter, the left ureter was replaced with ileum. She tolerated the procedure, postoperative serum creatinine declined, and recovery was uneventful.
What made this case unusual
Reconstruction was undertaken in hostile pelvic anatomy after prior pelvic surgery and radiotherapy, with dense fibrosis, bowel adhesions, an intrarenal pelvis, and long-segment ureteral obliteration.
Diagnostic / clinical pearl
When extensive ureteral loss cannot be managed with conventional reconstruction, ileal ureter replacement may serve as a salvage option in selected patients, even in complex pelvic anatomy.