Reconstruction of Ureteral Tissue Defect With Ileum Following Kidney Transplant in a Young Girl Due to Ureteral Stenosis and Necrosis: A Case Report.

Ureteral complications, particularly stenosis and necrosis, represent important challenges following kidney transplant. When endoscopic management fails due to extensive tissue loss, complex surgical reconstruction becomes necessary. We present the case of a 15-year-old female living donor transplant recipient who presented with urosepsis and hydronephrosis shortly after stent removal. After unsuccessful endourological intervention, surgical exploration revealed total ureteral necrosis. We performed a salvage reconstruction using a tapered, isoperistaltic segment of terminal ileum to bridge the defect. At the 3-year follow-up, the patient exhibited excellent graft function with a serum creatinine of 1.1 mg/dL, and imaging confirmed the absence of hydronephrosis. This case demonstrates that ileal ureter interposition serves as a safe and durable salvage technique for managing extensive ureteral defects. This technique offers effective long-term urinary drainage and graft preservation in young recipients when standard reconstructive options are not feasible.