Case Report – Renal Descensus as a Surgical Approach to Rupture of Proximal Ureter

Introduction and Case Report:

Ureteral rupture is a rare condition reported in veterinary medicine. It may be secondary to blunt trauma, penetrating injuries or iatrogenic, mostly during abdominal surgery 1 .

Direct anastomosis is a demanding surgical technique, due to the reduced diameter of the feline ureter and to the great proliferative capacity of the epithelium 2 . Post surgical obstruction is commonly reported as one of the major complications following surgery of the ureter 3 .

A 6 year-old spayed male domestic short hair cat was referred with signs of lethargy, abdominal pain and anuria for 12 hours secondary to being hit by a car. Medical treatment included intravenous fluid therapy, systemic antibiotics, anti-inflammatory drugs and pain control. Abdominal ultrasound showed no signs of abdominal effusion and blood analysis revealed leukocytosis, with neutrophilia and a moderate azotemia. 24 hours after admission there were just slight improvements on patient clinical condition so abdominal ultrasound was repeated. Since abdominal effusion was detected, exploratory laparotomy was performed in order to identify the origin of the effusion. The bladder integrity was confirmed and a large hematoma and inflammation involving the right kidney and retroperitoneal area was present. Under suspicion of ureteral rupture, an abdominal drain was placed. Azotemia resolved within 3 days and clinical signs improved, as the patient was alert and tolerating food. Six days after exploratory laparotomy the intravenous pyelogram confirmed a complete rupture of the right ureter in the proximal third, 2 centimeters from the ureteropelvic junction. Surgical approach included ureterneocystostomy after elongated cistoplasty through a boari flap and caudal kidney transposition (renal descensus).  […]