Diagnostic Neglect Regarding Ureter Ligation After Hysterectomy

Authors: YAŞAR BİLGE

Abstract: Complications following cesarean and hysterectomy operations can occur, one of which is ureter ligation. Aims: Urological injuries that occur during hysterectomy are rare but important causes of morbidity. It was aimed to investigate in this case report whether there was any evidence to support malpractice in Court. Case Report: The patient was a woman in her 34^3 week of pregnancy with familial Mediterranean fever (FMF) and nephrotic syndrome with renal amyloidosis. Preterm operational diagnosis was placenta previa totalis and repeat cesarean section was performed with confirmed consent. When the placenta spontaneously ruptured, hysterectomy was undertaken. Ureter ligation with acute renal failure was diagnosed later in another hospital. Left ureterolysis and dilation were performed. Discussion: Under normal operational processes, the ureter should be protected from ligation and cutting. The complication of ureter ligation and cutting incidence is reported in approximately 1.5% of procedures. The operation should be performed by skilled gynecologists and urologists trained in surgery of the pelvic retroperitoneum. This patient had FMF, amyloidosis and renal tubular necrosis due to hemorrhage. These factors were the main cause for acute renal failure. The precipitating factor was left ureter ligation, which accelerated the development of renal failure. For this reason, diagnosis should be done as soon as possible. The interval between operation and diagnosis of this case and treatment was approximately 46 days. Conclusions: Iatrogenic ureteric injury is still a major cause of harm and concern in hysterectomy. The patient is entitled to indemnification from hospital A. The patient was in great need of treatment as a result of the complication. Delayed diagnosis and treatment of ureter ligation is a neglect of the patient's rights. Our Social Security needs to be expanded to cover not only operations but also resulting complications.

Keywords: Obstetrics, hysterectomy, ureter injury, physician responsibility, complication, neglect

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