Retroureteral hernias are an uncommon post-operative complication. In this case, a 35-year-old woman developed a vesicovaginal fistula following an emergent cesarean section complicated by bladder and ureteral injuries. After undergoing fistula repair and ureteral reimplantation, she presented nearly two years later with symptoms of bowel obstruction. Diagnostic laparoscopy revealed that her right ureter, intraperitoneal along its distal half, was creating a band-like structure, entrapping the cecum, ascending colon, appendix, terminal ileum, and several loops of small bowel, resulting in an internal hernia. To address this, the surgical team carefully reduced the bowel loops and restored normal anatomy. They then retroperitonealized the ureter by sharply incising the peritoneum overlying the sacral promontory and right pelvic brim, extending down to the right paracolic gutter. The ureter was then covered with freed peritoneum using interrupted 2-0 vicryl sutures to prevent future entrapment of the bowel. Additional sutures were placed in the right paracolic gutter and cul-de-sac to eliminate potential spaces for bowel entrapment.
Postoperative imaging, including an antegrade nephrostogram and MAG3 scan, confirmed the absence of ureteral obstruction, and the patient experienced full resolution of her abdominal and flank pain. Retroureteral hernias are exceedingly rare, with only 10 documented cases, primarily occurring after radical hysterectomy, cystectomy with ileal conduit, or ureteral reimplantation. The timeframe of onset ranges from 12 days to 20 years post-surgery. In this case, the surgical approach successfully resolved the complication and preserved the ureteral reimplantation. This case highlights a valuable technique for managing retroureteral hernias, ensuring both the resolution of bowel obstruction and long-term preservation of the ureteral repair.
