You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information.
What is A 52-year-old woman undergoes a sigmoid resection with primary anastomosis for recurrent diveiculitis. She returns to the emergency room 10 days later with left flank pain and decreased urine output; laboratory examination is significant for a white blood cell (WBC) count of 20,000/mm3 . She undergoes a CT scan that demonstrates new left hydronephrosis, but no evidence of an intraabdominal abscess. Which of the following is the most appropriate next step in management? and explain in detail?
The patient should undergo an intravenous pyelogram for a suspected ureteral injury. After gynecologic surgeries, colorectal surgery is the most common cause of iatrogenic ureteral injuries. Intraoperatively, intravenous administration of methylene blue or indigocyanine green may facilitate identification of an injury. However, delay in diagnosis is common, and patients may present with flank pain, fevers, and signs of sepsis, ileus, or decreased urine output. CT scan may demonstrate hydronephrosis or a fluid collection (urinoma). Initial diagnosis and management should include urinalysis, although hematuria may not always be present; percutaneous nephrostomy tube or retrograde ureteral catheterization; percutaneous drainage of fluid collections; and identification of the location of ureteral injury. Surgical management should be delayed if diagnosis is late (10-14 days), and operative strategy is dependent on the location of the injury. Diagnostic imaging such as a pyelogram or nuclear medicine scan may be helpful to identify the site of the injury.