Intestinal obstruction and bilateral ureteral injuries after laparoscopic oophorectomylin a patient with severe endometriosis

M H Saidi, Saidi MH, Mo H. Saidi, Sarosdy MF, Michael F. Sarosdy, M F Sarosdy, P W Hollimon, Peter W. Hollimon, Hollimon PW, Sadler RK, R K Sadler, R. Kent Sadler
The Journal of the American Association of Gynecologic Laparoscopists · 1995 · vol. 2(3) , pp. 355–358 · doi:10.1016/s1074-3804(05)80124-0 · PMID:9050585 · W2032276299
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This case report details a patient who experienced intestinal obstruction and bilateral ureteral injuries following a laparoscopic oophorectomy performed for severe endometriosis.

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Abstract

The overall frequency of ureteral injury during laparoscopic adnexectomy for endometriosis is unknown, and intestinal obstruction after laparoscopy is rare. Our patient had two postoperative complications: small bowel obstruction and bilateral ureteral injuries discovered 2 and 39 days, respectively, after outpatient laparoscopic adhesiolysis and bilateral salpingo-oophorectomy for severe endometriosis. Pelvic examination and vaginal sonography revealed a large unilocular cystic mass. Laparoscopy showed a fixed large endometrioma firmly attached to pelvic peritoneum and intestines in the pelvic cavity, and significant adhesions in the upper part of a midline incision from prior abdominal hysterectomy. These midabdominal adhesions were not released. The patient underwent laparoscopic bilateral adnexectomy as an outpatient. Two days later she was admitted with small bowel obstruction. Thirty-nine days later, diagnostic evaluation revealed urinary ascites with right ureteral stricture at the uterine artery level, and complete ligation and resection of the left ureter at the pelvic brim near the infundibulopelvic ligament stump. She underwent left ureteral implantation with psoas hitch and right ureterolysis. Follow-up cystogram and intravenous pyelography at 6 and 20 weeks revealed complete recovery. In cases of severe endometriosis with significant ureteral and intestinal involvement, laparotomy may have to be considered.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Intestinal Obstruction Laparoscopy Ovarian Diseases Ovariectomy Ureter Adult Ambulatory Surgical Procedures Constriction, Pathologic Constriction, Pathologic Constriction, Pathologic Constriction, Pathologic Endometriosis Fallopian Tube Diseases Fallopian Tube Diseases Fallopian Tubes Fallopian Tubes Female Follow-Up Studies Humans

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License: CC0 · commercial use OK