Acute kidney injury secondary to iatrogenic bilateral ureteric ligation following emergency abdominal hysterectomy

Abstract

Background: Bilateral ureteric injury, although rare is a complication that could follow obstetric, gynaecologic and other pelvic surgeries. Majority of cases are diagnosed postoperatively, hence a high index of suspicion is required in patients who develop acute kidney injury (AKI) following abdomino-pelvic surgeries. Early diagnosis and intervention is key in the reversal of this uncommon type of AKI

Methods: We reviewed the case notes of a 47 year old female who was managed for AKI following abdominal hysterectomy.

Results: We present a case of 47 year old female who was referred to us 24 hours after she developed acute kidney injury following emergency abdominal hysterectomy on account of uterine rupture. There was significant haemorrhage before and during the surgery. Estimated glomerular filtration rate at presentation was 17 mls/min/1.73m² and abdominopelvic ultrasound showed bilateral obstructive uropathy. She received blood transfusion, haemodialysis, explorative surgery where both ureters were found to be ligated with evidence of bilateral hydroureters within 72 hours of referral. Bilateral ureteroneocystostomy was done with subsequent complete renal recovery.

Conclusion: Ureteric injuries should always be considered in all patients who develop AKI following abdomino-pelvic surgeries even in the presence of other possible causes such as haemorrhage. Abdominopelvic ultrasound scan should be done in these patients and early referral for specialist care is key to reducing associated morbidity and mortality.

Keywords: Bilateral ureteric injuries, acute kidney injury