During an abdominal hysterectomy, a surgeon injures the ureter. At which anatomical site is the ureter most vulnerable to injury during this operation?

• A At the level where it crosses the pelvic brim over the iliac vessels
• B Where it passes beneath the ovarian fossa peritoneum
• C Where the uterine artery crosses over it close to the cervix ✓
• D At its oblique intramural course through the bladder wall

Explanation

Near the cervix the ureter runs just beneath the uterine artery, the classic water under the bridge relationship, and it also lies close to the cardinal ligament and vaginal angle. Clamping or ligating the uterine artery during hysterectomy is therefore the point of greatest risk. Crossing the pelvic brim matters in colorectal and vascular surgery, and the intramural segment is narrowest but protected deep in the bladder wall, so those sites are less relevant here.

Reference: Gray's Anatomy for Surgeons, 42nd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.