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Case Reports in MedicineVolume 2009 2009, Article ID 326969, 4 pages

Case Report

Department of Urology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd. Weston, FL 33331, USA

Department of Internal Medicine, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd. Weston, FL 33331, USA

Department of Radiology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd. Weston, FL 33331, USA

Received 28 May 2009; Accepted 29 September 2009

Academic Editor: Eugene Minevich

Copyright © 2009 D. H. Kim et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Ureteral-iliac artery fistula UIAF is a rare life threatening cause of hematuria. The increasing frequency is attributed to increasing use of ureteral stents. A 68-year-old female presented with gross hematuria. She had prior low anterior resection for rectal cancer and a retained ureteral stent. CT abdomen and pelvis showed a large recurrent pelvic mass and a retained stent. The patient underwent cystoscopy which showed a normal bladder. Upon removal of the stent, brisk bleeding was noted coming from the ureteral orifice. Antegrade pyelogram was done which revealed a UIAF. Angiography was done and a covered stent was placed. Multiple treatment options are available. All must consider management of the arterial and ureteral side. The arterial side may be addressed by primary open repair, embolization with extra-anatomic vascular reconstruction, or endovascular stenting. The ureter can be managed with nephroureterectomy, ureteral reconstruction, placement of a nephrostomy tube, or ureteral stenting. Being minimally invasive, we believe that endovascular stenting should be the preferred therapeutic option as it also corrects the source of bleeding while preserving distal blood flow.





Autor: D. H. Kim, A. Mahdy, V. Mundra, M. Berman, and G. M. Ghoniem

Fuente: https://www.hindawi.com/



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