Iatrogenic Ureteral and Colonic Injuries During Emergency Cesarean Section: A Lesson Learned from a Surgical Catastrophe – A Case Report

INTRODUCTION: Iatrogenic concomitant ureteral and colonic injury in emergency cesarean section (C-section) is an exceedingly rare, yet, catastrophic complication and has not been reported to our knowledge. CASE REPORT: A 30-year-old woman presented with decreased urination for 2 days after a C-section. Ultrasonography showed severe left hydronephrosis and moderate abdominal free fluid. A ureteroscopy revealed a total occlusion of the left ureter, and subsequently, a ureteroneocystostomy was performed. Two days later, the patient was complicated with abdominal distension that necessitated re-exploration. The exploration revealed colonic injury (rectosigmoid), peritonitis, endometritis, and ureteral anastomosis disruption. A colostomy, repair of colonic injury, hysterectomy, and ureterocutaneous diversion were performed. The patient’s hospital stay was complicated, with stomal retraction requiring operative revision and wound dehiscence, which was treated conservatively. After 6 months, the colostomy was closed, and the ureter was anastomosed via the Boari-flap procedure. CONCLUSION: Injuries to the urinary and gastrointestinal tracts are serious complications of a cesarean section; concurrent involvement is exceedingly rare; however, delayed recognition and intervention can worsen the prognosis.