# Iatrogenic ureteral injury diagnosed after colon cancer surgery: A case report of a rare and challenging complication

## TL;DR

This case report describes a rare and severe complication of ureteral injury following colon cancer surgery, highlighting the importance of prevention and careful treatment.

## Contribution

The paper presents a detailed case of iatrogenic ureteral injury after colorectal surgery, emphasizing prevention strategies and treatment challenges.

## Key findings

- Iatrogenic ureteral injury is rare but can lead to life-threatening complications.
- Preoperative imaging and anatomical assessment are crucial to prevent ureteral injury.
- Treatment requires careful planning and skilled surgical intervention.

## Abstract

Iatrogenic ureteral injury (IUI) is an unfortunate and rare complication during colorectal surgery. While IUI remains a rare event, short and long-term complications are life-threatening ranging from intraperitoneal urinoma to septic shock and a serious risk of permanent renal failure.

An 88-year-old patient was admitted with symptoms of large bowel obstruction and underwent a laparotomy with a discharge colostomy. A week later, a second laparotomy was required for a non-functional retracted stoma, revealing a perforation in a sigmoid tumor. The patient then had an oncological sigmoidectomy with Hartman's colostomy. Postoperative findings indicated a left ureteral injury. Three weeks later, a ureterostomy was performed. Unfortunately, the patient succumbed to heart failure one week after the ureterostomy.

Low anterior and abdominoperineal resection of the rectum, along with sigmoid resection are the most frequent causes of ureteral injury in digestive surgery. The primary objective of management is to establish a continuous flow of urine to avert potential complications. Preventing IUI in colorectal surgery is of paramount importance. This process initiates in the preoperative phase with a meticulous assessment of ureteral and colic anatomy through comprehensive review of preoperative imaging.

IUI remains a seldom-seen, and yet a very serious complication in colorectal surgery. It is imperative to prioritize both preoperative and intraoperative measures to prevent IUI, ensuring optimal outcomes. When the diagnosis of a IUI is established, a treatment strategy should be meticulously devised and executed by a skilled and experienced surgeon.

•Iatrogenic ureteral injury is a seldom-seen complication in colorectal surgery.•It represents a devastating complication associated with significant morbidity and mortality rates.•Preventing Iatrogenic ureteral injury in colorectal surgery is of paramount importance.•Treatment can be intricate, requiring careful consideration of timing and the best technique for ureteral reconstruction.

Iatrogenic ureteral injury is a seldom-seen complication in colorectal surgery.

It represents a devastating complication associated with significant morbidity and mortality rates.

Preventing Iatrogenic ureteral injury in colorectal surgery is of paramount importance.

Treatment can be intricate, requiring careful consideration of timing and the best technique for ureteral reconstruction.