Reflex Anuria: A Complication of Hyperthermic Intraperitoneal Chemotherapy

Reflex anuria (RA) is a rare cause of abrupt reduction of urine output following trauma, irritation, or painful stimuli to the kidneys, ureters, or surrounding organs. The mechanism of RA is a reflex spasm of both ureters and/or renal arterioles. It is a well-documented complication of colorectal surgeries and gynecological surgeries which involve placement of a ureteric stent for ureteric identification and prevention of injury. RA and post-renal obstruction can both be complications of intraperitoneal hyperthermic chemotherapy (HIPEC) in patients who are undergoing surgery for colorectal cancer and peritoneal carcinomatosis. HIPEC procedure can lead to inflammation of the entire abdomen, including the ureters. This inflammation can result in hematuria that can form clots along the urinary tract and cause post-renal obstruction. The inflammation can also result in RA. It is essential to maintain high urine output during the early postoperative period to prevent clots and the ensuing post renal obstruction. It is also important to identify RA and maintain a low threshold to treat it by placing ureteric stents even in the absence of overt bilateral hydronephrosis.