Isa Khan, Mumtaz Khan, Gulzar Amin, Bakhtawar Gul, Ishaq M.
Augmentation Cystoplasty in an unusual case of Ureteric and Bladder rupture.
J Postgrad Med Inst Jan ;15(1):111-4.

A lady of 26 years with history of three consecutive C-Sections three times was admitted in the department of urology, Postgraduate Medical Institute, Lady Reading Hospital Peshawar as a case of post hysterectomy urinary leakages through the vagina and suprapubic wound. A general surgeon at the DHQ Hospital Bannu had tried to repair the urinary bladder after performing bilateral ureterostomies. As reported by the surgeon, the bladder was found torn into pieces and he could repair the shattered bladder with difficulty, left ureter was found ligated and there were irreparable injuries of the right lower ureter. She was referred to us for further work up and management. After a difficult exploration and dealing wit adhesions in the pelvic organs due to previous surgeries, we decided to perform Boaris flap ureteroneocystostomy, although the urinary bladder was not ideal due to its small capacity. On the third post operative day she developed faecal fistula through the suprapubic wound. This was probably due to unnoticed injury to the sigmoid colon, which was badly adherent to the urinary bladder. A surgical team mobilized the sigmoid colon as loop colostomy, once again performing intubated ureterostomes at the level of sacroiliac joints. Continued…

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