Delayed Ureteral Obstruction Due to Intramural Endo-Endoscopic Gastrointestinal Anastomosis Staples Following Laparoscopic Sigmoid Resection - A Case Report

Sep 28, 2026

Ureteral injuries are among the most significant urological complications associated with colorectal surgery, yet very delayed manifestations months or years after the index procedure are uncommon and difficult to diagnose. The report describes a 50-year-old woman with intermittent abdominal discomfort found to have a left mid-ureteral stone and grade I hydronephrosis. Six years earlier she underwent laparoscopic sigmoid resection with Endo-Gastrointestinal Anastomosis stapler use for diverticulitis. Ureterorenoscopy with laser lithotripsy removed two retained metallic staples, including one embedded in the ureteral wall and one within the stone matrix. Retrograde ureteropyelography and renal ultrasound confirmed resolution without residual stricture, supporting meticulous ureter identification and selective visualization techniques.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

Introduction

Background on iatrogenic ureteral injury

Risk factors in laparoscopic colorectal surgery

Staplers, delayed injury, and foreign body urolithiasis

How to cite this article

Review began 11/13/2025 Review ended 11/26/2025 Published 12/03/2025 © Copyright 2025 Madarasz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98395 Open Access Case Report Delayed Ureteral Obstruction Due to Intramural Endo-Endoscopic Gastrointestinal Anastomosis Staples Following Laparoscopic Sigmoid Resection: A Case Report Zsolt Madarasz 1, Bogdan-Cornel Sturzu 1, Krzysztof Nowakowski 1, Ewald Becker 2, Jens Hoeppner 1, Julia Michel 1, Anas Baltamar 1 1. Department of Surgery, Medical School and University Medical Center OWL, Campus Lippe, Bielefeld University, Detmold, DEU 2. Department of Urology, Medical School and University Medical Center OWL, Campus Lippe, Bielefeld University, Detmold, DEU Corresponding author: Zsolt Madarasz, [madaraszzsolt1984@gmail.com](madaraszzsolt1984@gmail.com) Abstract Ureteral injuries are among the most significant urological complications associated with colorectal surgery. Although most iatrogenic ureteral injuries are detected intraoperatively or shortly after surgery, a considerable number are identified only later. Very delayed manifestations that occur months or even years after the initial procedure are uncommon and pose diagnostic challenges. We report a case of a 50-year-old female patient who presented with intermittent abdominal discomfort and was found to have a left-sided mid-ureteral stone with grade I hydronephrosis. Her surgical history included an elective laparoscopicsigmoid resection six years earlier for a covered perforation secondary to sigmoid diverticulitis, during which an Endo-Gastrointestinal Anastomosis (GIA) stapler was used. Ureterorenoscopy with laser lithotripsy revealed two metallic staples, one embedded in the ureteral wall, and another encased within the stone matrix, both successfully removed endoscopically. Postoperative retrograde ureteropyelography and renal ultrasound confirmed resolution of the obstruction without residual stricture. To our knowledge, this represents the first documented case of delayed ureteral obstruction caused by retained intramural and intraluminal Endo-GIA staples. The presumed mechanism involves inadvertent staple incorporation during pelvic dissection, followed by chronic foreign body reaction and subsequent stone formation. Endoscopic treatment proved effective, avoiding the need for reconstructive surgery. This case highlights the importance of meticulous ureteral identification during pelvic procedures and supports the selective use of visualization-enhancing techniques in high-risk surgical settings. Categories: Urology, General Surgery Keywords: delayed ureteral obstruction, flexible ureterorenoscopy, foreign body urolithiasis, intramural staple, laparoscopic colorectal surgery, surgical stapler complication, ureteral injury Introduction Iatrogenic ureteral injuries are uncommon but potentially serious complications of pelvic and colorectal surgery, and their incidence is strongly influenced by the surgeon’s experience and the complexity of the operative field. Reported incidence rates range from 0.3% to 1.5% in elective abdominal operations, underscoring that even minimally invasive approaches carry inherent risk [1,2] . A large retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) database found an incidence of approximately 0.6%, reinforcing the clinical relevance of this complication [3] . Laparoscopic sigmoid resection performed in the setting of complicated diverticulitis poses a particularly high risk for ureteral injury due to inflammation, adhesions, and distorted anatomical planes. Prior studies have shown that laparoscopic colectomy is associated with a higher incidence of ureteral injury compared to open procedures, espe

FAQs

Why are delayed ureteral injuries after colorectal surgery difficult to diagnose?

Because manifestations that occur months or even years after the initial procedure are uncommon and diagnostic challenges arise long after the index operation.

What findings led to the diagnosis in the reported case?

The 50-year-old woman presented with intermittent abdominal discomfort, and imaging identified a left mid-ureteral stone with grade I hydronephrosis.

How were the ureteral obstruction and retained staples treated, and what was the outcome?

Flexible ureterorenoscopy with laser lithotripsy removed two retained metallic staples, and postoperative retrograde ureteropyelography and renal ultrasound confirmed resolution of the obstruction without residual stricture.

Sep 28, 2026

Uploaded by pixelkiddo