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Paraureteric space post-ureteric re-implantation: a rare cause of small bowel obstruction
  1. Martina Spazzapan1,
  2. Roberta Bullingham1,
  3. Nkwam Michael Nkwam2 and
  4. Efthymios Ypsilantis1
  1. 1Princess Royal University Hospital, Department of Surgery, King's College Hospital NHS Foundation Trust, London, UK
  2. 2Urology, King's College Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Martina Spazzapan; martina.spazzapan{at}


A female patient in her 80s presented with a 2-day history of abdominal pain and absolute constipation, having previously undergone a robotic left distal ureterectomy with ureteric re-implantation. CT revealed a closed-loop small bowel obstruction with transition point adjacent to the left ureter and resultant upstream hydronephrosis. An emergency laparotomy revealed small bowel herniation into a paraureteric space created by her previous surgery and defined by the distal ureter medially, the common iliac vessels laterally and the mobilised bladder dome anteriorly. The viable small bowel was reduced, and the space was eliminated by omental flap transposition after omentoplasty. The patient made a full recovery. Preoperative diagnosis of such an unusual cause of internal herniation can be challenging. This very rarely reported case raises awareness of the condition and proposes a treatment strategy.

  • Gastrointestinal surgery
  • General surgery
  • Urological surgery
  • Urological cancer

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  • Contributors MS and RB contributed equally to this paper and are to be considered joint first authors. They both provided substantial contributions to the conception of the work and drafted the paper. NMN provided senior urological input at the time of patient presentation as well as during write-up of the case. EY was the consultant in charge of the patient and provided senior surgical supervision throughout the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.