CME Journal of Clinical Case Reports
ISSN: 3067-7998 | DOI: 10.64030/3067-7998
Sewunet Muluneh, Bedri Kazali, Admasu Melaku, Tsion Nigussie, Gizaw Bitie and Anmut Woretaw
Introduction
Boari flap is a reliable technique to reconstruct ureteral defect regardless of their site. The most common complication after initial boari flap is recurrent ureteric stricture. The recurrent ureteric stricture after initial Boari flap is very rarely managed with re-do boari flap with only two cases done by one author from the same centre making our case the third one.
Case Presentation
We report a case of 33-year-old female patient who had iatrogenic ureteric injury during the third caesarean section which was managed with ultrasound guided Right percutaneous nephrostomy tube insertion on third post-operative day followed by initial boari flap after two and half month of injury. Subsequently, the patient put on stent exchange for one year after initial boari flap for recurrent at which time re-do boari flap was done.
Clinical Discussion
Despite technical difficulties due to adhesion arising from prior surgery, re-do Boari flap was performed, using an open approachafter transacting the stenotic segment above the level of the previous flap and ureter was re-implanted to a newly formed Boari flap. Patient is symptom free at second, third- and fourth-month post operatively on follow up with no hydronephrosis on ultrasound.
Conclusion
Re-do Boari flap for recurrent ureteric stricture after prior Boari flap has good outcome but studies with large volume of patient with longer duration of follow up is recommend. Re-do Boari flap for recurrent Boari flap anastomotic stricture, without the use of a bowel segment or augmentation, hence avoids both long term and short complications associated with bowel use.