Extensive cellulitis as the first symptom of ureter lesion after laparoscopic hysterectomy

Abstract

Laparoscopic hysterectomy as an alternative to abdominal hysterectomy is frequently performed for benign uterine pathology. Although laparoscopic hysterectomy is associated with less pain, quicker recovery, and better short-term quality of life, it is associated with an increased risk of ureter lesions compared with the open procedure. We point out the case of a woman who underwent a total laparoscopic hysterectomy and presented postoperatively with a cellulitis at the right side of the body expanding over the abdomen and the pelvis, and subsequently problems with micturition. Computed tomography demonstrated a lesion of the left ureter nearby the ureterovesical junction. Cellulitis was treated with clindamycin, and a nephrostomy catheter was placed since the placement of a Double-J stent was not possible. Six weeks after surgery, a ureter re-anastomosis was performed by laparotomy. Urine leakage into the abdomen combined with urinary tract infection or infection of the wounds can lead to rapid extension of cellulitis and is therefore an important additional symptom for urological complications after a laparoscopic hysterectomy.