A case of delayed bilateral ischemic necrosis of the pelvic ureter in a 66-year-old woman submitted to abdominal perineal resection and hysterectomy for advanced rectal cancer, is reported. Five days after the operation urine was observed in the perineal cavity. External urine diversion was carried out by catheterizing the ureteral stumps through the perineal cavity. The reconstructive procedure was performed at a later date by bilateral ureteroileocystoplasty with a defunctionalized loop. The vascular anatomy of the ureter is discussed to highlight the essential technical details useful for prevention of ischemic injury.
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