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.
Subject(s)
Endometriosis/surgery , Intestinal Obstruction/etiology , Laparoscopy/adverse effects , Ovarian Diseases/surgery , Ovariectomy/adverse effects , Ureter/injuries , Adult , Ambulatory Surgical Procedures , Constriction, Pathologic/diagnostic imaging , Constriction, Pathologic/etiology , Constriction, Pathologic/surgery , Fallopian Tube Diseases/surgery , Fallopian Tubes/surgery , Female , Follow-Up Studies , Humans , Hysterectomy , Intestinal Diseases/surgery , Intraoperative Complications , Peritoneal Diseases/surgery , Radiography , Tissue Adhesions/surgery , Ureter/diagnostic imaging , Ureter/surgery , Ureteral Diseases/diagnostic imaging , Ureteral Diseases/etiology , Ureteral Diseases/surgeryABSTRACT
Hepatobiliary scintigraphy using Tc-99m labeled radiopharmaceuticals is employed primarily for the diagnosis of acute cholecystitis and for demonstration of biliary tract potency. This produce may also provide diagnostic information in the identification of unusual or atypical hepatobiliary disorders; frequently, this occurs as an incidental result of the test. We present five cases in which trauma, infection, or obstructive abnormalities were diagnosed fortuitously.
