PMC9201503_01
Abdominal ultrasound image of left and right kidney and proximal ureter including pelvic dilation and ureteral dilation.
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F1
In total, 12 h post admission to the intensive care unit (day 1), an abdominal ultrasound was performed, revealing bilateral hydronephrosis (right renal pelvis = 11 mm, left renal pelvis = 10 mm) and hydroureter (Figure 1).
Cranial is at the top. The image shows a close-up view of the sutures, intact, surrounding both ureters within the left retroperitoneal space immediately upon entry into the abdomen, prior to dissection. The right ureter (white arrowhead) and left ureter (white arrow) are both entrapped with a hematoma caudal to the ligatures with a cotton-tipped applicator pointing to it in the lower left of the image.
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F2
Both the ureters were tracked cranially where multiple sutures were found to be encircling both ureters in combination with the right vas deferens (Figures 2, 3). The right ureter was freed via removal of the encircling ligature (Figure 2) and three additional sutures were dissected and removed to free the left ureter.
Cranial is to the left. The surgeon is retracting the descending colon to the patient's left side to demonstrate the region of interest following dissection and removal of the encircling ligatures. The proximal end of the left ureter (white arrow) is shown with significant dilation. Following dissection, the proximal and distal ends of the left ureter were found to be completely separate within the large hematoma shown.
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F3
Both the ureters were tracked cranially where multiple sutures were found to be encircling both ureters in combination with the right vas deferens (Figures 2, 3). The left ureter was strictured and found to be non-patent based on the inability to pass a 0.025''guidewire retrograde from the cystotomy incision past the area of concern, with additional evidence of partial transection (Figure 3).