Table IV.
Ureteral injuries associated with adnexectomy (BMI- Body mass index, NA- Not available, POD- Post operative day, LSO- Left salpingo-oophorectomy, RSO- Right salpingo-oophorectomy, IVP- Intravenous pyelography, US- Ultrasound).
| Case/Year | Age | BMI | Comorbidity | Indications | Surgery | Presentation | Investigation/Intervention | Legal outcome |
|---|---|---|---|---|---|---|---|---|
| 17/1997 | 45 | NA | 4 laparotomies including TAH and LSO | Pelvic pain, pressure. 13 cm right ovarian cyst | Laparotomy: Difficult RSO, extensive adhesiolysis. Unable to identify ureter | POD #1-6: Intermittent right flank pain, vomiting. leukocytosis POD #7: Pathology reported a segment of ureter | POD #8: IVP-Rt hydronephrosis, obstructed ureter. Percutaneous nephrostomy. Laparotomy: Ureteroneocystotomy | Settlement |
| 18/1998 | 49 | NA | Obesity, 2 laparotomies | Pelvic pain, 13 cm pelvic cyst | Laparotomy: Retroperitoneal pelvic cyst excision, extensive adhesiolysis. Ureters not identified | POD#2: Smell of urine in abdominal drain POD #7: Uretero-rectal fistula |
POD #2: Retrograde pyelogram-Left ureteral injury. Laparotomy: ureteral injury repaired POD #7: Colostomy for ureterorectal fistula |
Trial: Negligence for ureter but not for bowel |
| 19/2001 | 42 | 55 | Obesity, Multiple laparotomies including TAH | Pelvic Pain. 12 cm right ovarian mass | Laparotomy: Right oophorectomy. Ureter identified retroperitoneally. | POD #11: Pelvic pain, back pain, urinary retention | POD #11: IVP/US/Cystoscopy- Right ureteral injury. Percutaneous nephrostomy 2 months: Laparotomy- reimplantation | Dismissed |
| 20/2010 | 41 | 46 | Previous TAH | Pelvic pain. Bilateral complex ovarian cysts | Laparotomy: Bilateral oophorectomy. Adhesiolysis. Ureters identified. | POD #10: Left abdominal pain | POD #10: IVP/US-Left hydronephrosis, metal clip obstructing left ureter. Percutaneous nephrostomy. 2 months: Laparotomy- Reimplantation using Boari flap | Settlement |