Antegrade deligation of iatrogenic distal ureteric obstruction utilising a high pressure balloon dilatation technique.

BACKGROUND: Iatrogenic trauma is the leading cause of ureteric injury with an incidence in abdominal and pelvic surgery varying between 0.4 and 2.5%. CASE: We report a case of ureteric obstruction caused by a haemostatic clip. There was associated rupture of the ureter proximal to the clip with intra-peritoneal leakage of urine. The patient was unfit for surgery and was managed by a novel procedure of endoluminal balloon deligation. CONCLUSION: Ureteric injuries are rare but potentially serious complications. They require prompt diagnosis and management depends on the patients' clinical condition, extent of injury and interval from injury to diagnosis. We have successfully demonstrated a new technique to treat ureteric obstruction caused by a haemostatic clip with associated ureteral rupture in a patient unfit for surgery.

Three dimensional reconstruction of CT scan images to aid the cardiac surgeon.

Minimally invasive techniques and approaches have the potential advantages of less operative stress and healthcare resource utilization but at the "cost" of less operative field of view. Newer imaging techniques utilizing three dimensional reconstruction of computed tomography scan images (3DCT) can aid the cardiac surgeon in visualizing the geometric relationships to plan and execute complex surgical procedures via minimally invasive or standard approaches. Multidetector-row CT scanning and post-processing yield these 3DCT images. We describe representative examples of this imaging technology in planning complex surgical procedures. Vascular structures, pulmonary and atrial venous relationships and cardiac ventricular functional anatomy are all visualized. Utilizing advances in imaging should allow surgeons to rapidly adopt newer technologies and minimally invasive techniques.