Management of uretero-colonic fistulas and ureteral injuries: a comprehensive surgical and endoscopic approach

Pediatric ureteral injuries can arise from trauma or surgical procedures, and urinary-enteral fistulas, although rare, are both challenging to manage and repair. More information is needed regarding ureteral-enteral fistulas in the general population, and successful treatment options are limited. This case report introduces an innovative approach, treatment, and successful follow-up featuring a novel repair technique designed for pediatric patients.

As a result of complicated appendicitis, a 2-year-old male developed a uretero-enteral fistula. A right ureteral-enteral fistula was detected, and because of the persistent metabolic acidosis and deteriorating malnourishment, a percutaneous nephrostomy tube was inserted with the closure of the fistula through a colonoscopy clip. Three months later, with a better patient’s condition, corrective ureteral surgery was performed with total resection of the fistulized ileocolonic segment (an anastomosis previously made because of the ileocecal valve resection secondary to appendiceal process) and total reconstruction of the urinary tract using a Boari vesical flap. The postoperative course was satisfactory.

Managing the ureteral-enteral fistulas is a surgical challenge due to their diverse etiology and presentation. An effective surgical management plan requires a comprehensive understanding of ureteral injuries and associated conditions and an examination of the patient's urological anatomy and function to tailor the best treatment for each case.