# Delayed Ureteral Obstruction Due to Intramural Endo-Endoscopic Gastrointestinal Anastomosis Staples Following Laparoscopic Sigmoid Resection: A Case Report

## TL;DR

A patient developed a delayed ureteral blockage six years after surgery due to retained staples, which were successfully removed endoscopically.

## Contribution

First documented case of delayed ureteral obstruction caused by retained Endo-GIA staples.

## Key findings

- Two metallic staples were found embedded in the ureteral wall and within a stone matrix.
- Endoscopic removal resolved the obstruction without the need for reconstructive surgery.
- The case suggests a chronic foreign body reaction led to stone formation around the staples.

## Abstract

Ureteral injuries are among the most significant urological complications associated with colorectal surgery. Although most iatrogenic ureteral injuries are detected intraoperatively or shortly after surgery, a considerable number are identified only later. Very delayed manifestations that occur months or even years after the initial procedure are uncommon and pose diagnostic challenges. We report a case of a 50-year-old female patient who presented with intermittent abdominal discomfort and was found to have a left-sided mid-ureteral stone with grade I hydronephrosis. Her surgical history included an elective laparoscopic sigmoid resection six years earlier for a covered perforation secondary to sigmoid diverticulitis, during which an Endo-Gastrointestinal Anastomosis (GIA) stapler was used. Ureterorenoscopy with laser lithotripsy revealed two metallic staples, one embedded in the ureteral wall, and another encased within the stone matrix, both successfully removed endoscopically. Postoperative retrograde ureteropyelography and renal ultrasound confirmed resolution of the obstruction without residual stricture. To our knowledge, this represents the first documented case of delayed ureteral obstruction caused by retained intramural and intraluminal Endo-GIA staples. The presumed mechanism involves inadvertent staple incorporation during pelvic dissection, followed by chronic foreign body reaction and subsequent stone formation. Endoscopic treatment proved effective, avoiding the need for reconstructive surgery. This case highlights the importance of meticulous ureteral identification during pelvic procedures and supports the selective use of visualization-enhancing techniques in high-risk surgical settings.