A rare curious case of ureteric dissection in a patient with vaginal vault recurrence of endometrial carcinoma

Abstract Background Ureteric dissection (UD) is a rare and complex condition characterized by the separation of the ureter’s inner mucosal layer from the middle muscular layer, often resulting in the formation of a potential space where urine can accumulate. Timely diagnosis is crucial as UD can progress to severe complications like ureteric rupture if not managed appropriately. Advanced imaging techniques are essential for the early detection and effective management of this rare condition. The aim of this case was to highlight the radiological features of ureteric dissection secondary to recurrent pelvic malignancy and to emphasize the pivotal role of cross-sectional imaging in its diagnosis and management. Case presentation We present the case of a 43-year-old female who presented with a 2-week history of persistent left flank pain, nausea, reduced appetite, and foul-smelling vaginal discharge with occasional blood-tinged spotting over the past 2 months. Her surgical history included an abdominal hysterectomy 5 years earlier for grade 3 endometrial carcinoma, with no significant postoperative complications. On examination, she had left flank tenderness but no palpable masses. Imaging studies, including abdominal ultrasound and contrast-enhanced CT, revealed mild to moderate left-sided hydroureteronephrosis with a “double lumen sign” and a mass at the left vesicoureteric junction. The CT scan confirmed ureteric dissection with a periureteric collection and identified a heterogeneous 8 × 7 cm mass in the vaginal vault. A biopsy confirmed recurrent endometrioid adenocarcinoma. The patient underwent an emergency percutaneous nephrostomy to decompress the obstructed renal collecting system and was started on chemotherapy. Follow-up imaging is planned in 3 months to assess the treatment response. Conclusion This case highlights the rarity of ureteric dissection and underscores the importance of advanced imaging techniques for its timely diagnosis. Early detection of UD through imaging is vital for preventing severe complications such as ureteric rupture. This case contributes to the limited literature on ureteric dissection and highlights the importance of prompt intervention in managing this challenging condition.