DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Ureteral injury.
POSTOPERATIVE DIAGNOSIS: Partial right ureteral avulsion.
PROCEDURE PERFORMED: Exploratory laparotomy, repair of right ureter, drainage of urine ascites.
SURGEON: John Doe, MD
ANESTHESIA: General.
INDICATIONS FOR PROCEDURE: The patient is a (XX)-year-old male who underwent right ileocolic resection for recurrent Crohn disease four days ago. At the time of surgery, he was noted to have a chronic anastomotic perforation and ileocolic-duodenal fistula. The surgery was notably difficult, but the patient overall did well. Postoperatively, he was noted to have rising creatinine. A CT scan was performed and showed extravasation of urine in the pelvic inlet portion of the ureter. It was recommended that he undergo exploratory laparotomy and cystoscopy with possible repair of ureter. In retrospect, the patient explained postoperatively that he did have a ureteral injury and psoas hitch at the first procedure.
FINDINGS AND DESCRIPTION OF PROCEDURE: Informed consent was obtained. The patient was taken to the operating room and placed in the supine position. After adequate induction of general anesthesia, the patient was placed in the lithotomy position. Dr. Jane Doe first performed cystoscopy, retrograde pyelogram, and placement of a stent. Fortunately, there was no clear transection of the ureter but just partial injury. This was dictated separately.
The prior abdominal incision was then opened for its entire length. There was noted to be about 4 L of urinary ascites within the abdomen. There were no adhesions. The bowel was free floating. The bowel was packed out of the way, and at the site of extravasation, we examined the ureter carefully. This was at the pelvic inlet, far distal to where our dissection plane was. There was noted to be a single transverse, linear laceration of the anterior aspect of the ureter. This was repaired with three sutures of 4-0 PDS. The abdomen was thoroughly irrigated with saline.
A 19-French Blake drain was brought through a separate stab incision in the right lower quadrant and placed over the ureteral area. Seprafilm was placed with subfascial placement. The fascia was closed with a running continuous suture of #1 looped PDS. The skin was closed with skin clips. The patient tolerated the procedure well. There were no complications. Postoperatively, he was extubated and transferred to the recovery room in stable condition.
