UC Irvine

Bilateral long-segment ureteral transection during colorectal surgery is an exceptionally rare and complex complication that demands immediate multidisciplinary management. When primary reimplantation is unfeasible, urinary diversion may serve as a temporizing measure to preserve renal function and stabilize the patient until definitive reconstruction becomes feasible. We report the case of a 43-year-old male who sustained bilateral ureteral transection exceeding ten centimeters during laparoscopic sigmoid resection for an obstructing colonic mass. Given the high, proximal level of injury, direct ureteroneocystostomy with or without Boari flap was not possible, and the patient underwent immediate urinary diversion with an ileal conduit using Bricker ureteroenteric anastomoses. The postoperative course was complicated by a colocutaneous fistula and ventral hernia, which were managed conservatively. After a period of eighteen months, comprehensive reassessment demonstrated preserved renal function, a healthy ileal loop, and a bladder with approximately five-hundred-milliliter capacity. A multidisciplinary reconstruction was performed to reconnect the ileal loop to the bladder dome, accompanied by simultaneous fistula takedown, sigmoidectomy, and abdominal wall repair using transversus abdominis release with mesh reinforcement. The postoperative cystogram was negative for leakage, and follow-up cystoscopy one year later confirmed a well-healed anastomosis. The patient has remained free of hydronephrosis or infection, reporting only mild nocturia and occasional elevated postvoid residuals managed conservatively. This case highlights that, in selected patients with bilateral ureteral transection, early ileal diversion may serve as a renal-preserving bridge to later functional undiversion when coordinated through multidisciplinary planning.