Home > Cases > Main Index > Case 50 | G.U. Index  

SRS-X The SRS Educational Resource

Case 50

Post operative uretero-enteric fistula with gas in the renal tract

A lady with post operative urinary infections

This 63 year old lady underwent a Wertheim's hysterectomy for carcinoma. She suffered severe post operative haemorrhage and sepsis, and required repeat surgery to control the bleeding. She developed multiple organ failure, spending three months on intensive care before recovering.

She was eventually discharged home in fair health, but returned after a few weeks with persistent urinary tract infecton despite antibiotics. She complained that her urine was permanently discoloured.

A control film and prone 25 minute film are provided from an IVU examination.

Findings

Control film:

• Gas within the left renal collecting system and ureter (negative pyelogram effect)
• Gas within the bladder (abnormal crescentic gas collection in the pelvis)
• Surgical clips overlying the left lower ureter

25 minute film

• The left kidney excretes contrast
• There is irregularity of the left side of the bladder
• There is contrast extending outside the ureter, into either peritoneum or bowel.

Diagnosis

Post operative uretero-enteric fistula with gas in the renal tract

Discussion

The ureter had been damaged during the second operation while attempting to stem her severe haemorrhage. In time she developed a fistula to her small bowel, allowing gas and faecal material to enter her renal tract, causing the above signs and her recurrent infectons.

Main Index  |   Previous Case

G.U. Index  |   Previous Case

Main Index as Unknowns

G.U. Index as Unknowns