PICTORIAL

Iatrogenic Ureterocolic Fistula Following Laparoscopic Oophorectomy

Michael S Floyd Jr,* Luke Hanna, Melissa C Davies.

Keywords: fistula; laparoscopy; iatrogenic; ureter; oophorectomy.

A 56 year old lady presented with gradual onset left flank pain, rigours and diarrhoea. Her past history was re-markable for an uneventful, elective bilateral laparoscopic oophorectomy one month earlier under the Gynae-
cology service. She had previously had breast cancer and was BRCA2 positive. On examination she was pyrexial 
and tender in her left flank. Computerised tomography revealed moderate left sided hydronephrosis, extensive air 
within her left renal pelvis and a distal left ureterocolic fistula (Figures 1-3). She was initially managed with anti-
microbial therapy and stenting but eventually required a ureteric reimplantation.
 Ureterocolic fistulae are rare and may occur as a result of iatrogenic injury(1). Diverticular disease causing spon-
taneous ureterocolic fistulae has been reported(1,2) but the majority of cases occur due to impacted ureteric calculi. 

Department of Urology, Salisbury NHS Foundation Trust, Wiltshire, SP2 8BJ, United Kingdom.
*Correspondence: Clinical Fellow in Neurourology, Department of Urology, Salisbury NHS Foundation Trust, Wilt-
shire,SP2 8BJ, United Kingdom.
E mail: nilbury@gmail.com
Received January 2016 & Accepted October 2017

Figure 1. Computerised Tomography of the abdomen demonstrat-
ing gas in the left renal pelvis with a simple renal cyst and a normal 
contralateral kidney.

Figure 2. Computerised Tomography of the Abdomen demonstrat-
ing air in the mid and distal left ureter consistent with a uretero-
colic fistula.

Figure 3. Plain X ray of abdomen demonstrating faecal 
loading and air in the left ureter extending up into the col-
lecting system.

Pictorial  220



Ureterocolic fistula after lap. Oophorectomy-Floyd et al.

Predisposing factors include inflammation, radiation, 
surgical trauma and neoplastic processes. Diagnosis is 
made via abdominal imaging(3) or intraoperative retro-
grade studies(1). Management is usually surgical with 
either nephroureterectomy in cases of a poorly func-
tioning kidney or segmental  resection, ileostomy and 
stenting in selected cases. Conservative management 
has been described(3). As the incidence of elective oo-
phorectomy for cancer prevention increases it is likely 
that this form of ureteric injury will become more prev-
alent.

REFERENCES
 1.  Dowling CM, Floyd jr MS, Power RE, JM 

Hyland, DM Quinlan. Ureterocolic fistula in 
the presence of a solitary kidney. BMJ Case 
Rep. 2009;2009. pii: bcr06.2008.0301. doi: 
10.1136/bcr.06.2008.0301. Epub 2009 Feb 2. 

 2.  Cirocco W, Priolo SR, Golub RW. Spontaneous 
ureterocolic fistula: a rare complication of 
colonic diverticular disease. Am Surg 1994; 
60: 832–5

 3.  Iwamoto Y, Kato M. A case with 
fistula formation between a perinephric 
retroperitoneal abscess, a ureter and a 
descending colon: Successful outcome after 
conservative management. Can Urol Assoc J. 
2014 Sep;8:E644-6.

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