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Right ureteric reconstruction with vascularised interpositional appendix graft in retroperitoneal leiomyosarcoma
M Sohail1, S N Loke2, S K Sim3
1Universiti Malaysia Sarawak, Faculty of Medicine and Health Sciences, Kota Samarahan, Sarawak, Malaysia. msohail@unimas.my.
The Medical Journal of Malaysia
|May 25, 2021
Summary
A retroperitoneal leiomyosarcoma involving the ureter required complex reconstruction. An interpositional vascularized appendix graft successfully repaired a large ureteral defect, showcasing an uncommon surgical technique.
Area of Science:
- Urology
- Surgical Oncology
- Gastrointestinal Surgery
Background:
- Retroperitoneal leiomyosarcomas are rare soft tissue tumors.
- Tumor involvement of adjacent structures like the ureter presents significant surgical challenges.
- Ureteral reconstruction after extensive tumor resection can be complex.
Observation:
- A 66-year-old female presented with a right iliac fossa retroperitoneal leiomyosarcoma.
- The tumor extensively involved the right ureter, causing hydroureter and hydronephrosis.
- Direct ureteral repair was not feasible after en-bloc tumor resection.
Findings:
- A 7 cm ureteral defect was successfully reconstructed using an interpositional vascularized appendix graft.
- This technique allowed for tension-free anastomosis and preservation of renal function.
- The surgical approach highlights a novel solution for extensive ureteral defects.
Implications:
- Vascularized appendix grafts offer a viable option for complex ureteral reconstruction.
- This case expands the reconstructive armamentarium for retroperitoneal tumors involving the urinary tract.
- Further studies are warranted to evaluate the long-term outcomes of this reconstructive method.
