Ureteral avulsion during uterine dilatation and evacuation: a case report
Norman L Meyer1, Ilana B Addis, Gary H Lipscomb
1Division of Gynecologic Specialties, Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis 38163, USA. nmeyer@utmem.edu
Background:
Ureteral injury during elective pregnancy termination is rare and has been reported only 8 times. Two of these cases involved avulsion, and 1 occurred during a second-trimester procedure.
Case:
Ureteral avulsion and damage to the lower colon occurred during second-trimester pregnancy termination. Although the ureter was initially thought to be intact on direct visualization of the pelvic ureter and stent placement, pathologic evaluation of the curettage specimen revealed a segment of ureter. Subsequently, intravenous pyelography confirmed ureteral avulsion at the junction of the ureter with the kidney.
Conclusion:
Although damage to the ureter at the time of uterine evacuation is unusual, use of intraoperative intravenous pyelography may be advisable when injury is suspected but not obvious.