Boari Flap Urinary Tract Reconstruction for Rectosigmoid Cancer with Ureteral Invasion: Report of a Case

Abstract

Introduction The Boari flap technique is a unique urinary tract reconstruction procedure performed after resection of the urinary tract. However, few previous reports have described the application of this technique to gastrointestinal cancer. Moreover, we have not found any papers describing the long-term prognosis. We report a case of right ureteral tract resection followed by Boari flap reconstruction for rectosigmoid carcinoma, with survival for 108 months without any urologic complications. Case presentation A woman in her 50s was diagnosed with rectosigmoid cancer by a local physician and referred to our institution. Computed tomography scans revealed right hydronephrosis caused by rectosigmoid cancer invasion at the lower two-thirds of the right ureter. During laparotomy, massive lymphatic infiltration from the primary lesion to right ureter was observed. After primary tumor resection with lower ureter excision, the Boari flap procedure was performed to reconstruct the ureteral deficit. The postoperative course was uneventful, and she was discharged on postoperative day 20. The patient has been seen every 4 months for 9 years with no recurrence or unpleasant symptoms. Discussion This technique is usually performed to manage specific conditions such as ureteral stenosis caused by ureteral calculi, retroperitoneal fibrosis, and gynecologic disorders. This procedure should be reconsidered as a possible option for gastrointestinal malignant cases instead of nephrostomy or cutaneous ureterostomy, given the low rate of complications and high patient satisfaction. Conclusion The Boari flap technique is particularly useful for bridging between the ureter and bladder in cases of colorectal malignancy with combined resection of the lower urinary tract.