Abstract
A case report: We will report on a case which suffered from right hydronephrosis after total laparoscopic hysterectomy. In addition, the same patient encountered a strangulated ileus by internal hernia after ureteroneocystostomy and mechanical ileus after that surgery. The patient was a-56-year-old-woman with regular menstruation who underwent the laparoscopic hysterectomy and bilateral adnexectomy. On the 32th postoperative day observations showed that the stenosis of the ureter had caused hydronephrosis on the right side and a ureteral stent was placed. As the stent placement did not solve the stricture after some months, laparoscopic ureteroneocystostomy using both the Boari flap and psoas hitch techniques to cover the large ureteral defect, was performed on the 7th month after the initial surgery. On the 43rd post-operative day after the uteroneocystostomy, the patient suffered severe pain due to an internal hernia between the space of the bladder and the iliopsoas muscle, and underwent a laparotomy by general surgeons to resolve strangulation of the bowel. As the post-operative course was unfavorable, she underwent her 4th surgery, a laparotomy for bowel obstruction because of adhesion of the bowel to the previous dissection site.
Hydronephrosis is one of the more common complications after total laparoscopic hysterectomy and sometimes the course of treatment can become difficult. This patient is a rare case in that a domino effect of complications occurred after each stage of treatment and surgery. This case highlights the need for strict observation and management of all cases, to prevent extension of the course of treatment of the original disease.
