ANURIC ACUTE-RENAL-FAILURE DUE TO BILATERAL ACCIDENTAL URETERAL LIGATION DURING ABDOMINAL HYSTERECTOMY

OBJECTIVE: To determine the incidence of accidental ureteric ligation causing acute anuric renal failure (AARF) at the KorleBu Teaching Hospital, Accra, Between August 1984 and December 1991. METHOD: The records and operative data of all cases managed with acute anuric renal failure at the hospital during the period were reviewed. RESULT: The 7 patients with AARF presented with mean pre-referral anuria of 3.2 days. Total abdominal hysterectomy (4 for fibroids, 2 for carcinoma of uterus and 1 for post partum hemorrhage) was the cause of ureteric ligation. The 7 patients mean age 38.5 years were anemic (mean HB 4.1 g/dl) and uremic (mean blood urea 40.51 mmol/l) on admission. Abdominal ultrasonography was useful for diagnosis of obstructive uropathy. Hemodialysis was required in all cases prior to laparotomy and ureteroneocystostomy. The ureters were usually ligated at the distal 3 cm. Five survived ureteroneocystostomy and 2 died before laparatomy from septicemia and/or pulmonary edema. CONCLUSION: Abdominal hysterectomy is a major cause of anuric acute renal failure and early recognition and treatment prevents death.