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DOI: 10.1055/s-0043-103403
Endoscopic closure of a fistula between an ileal conduit and an ileal handle localized between two uretero-ileal anastomoses
Corresponding author
Publikationsverlauf
Publikationsdatum:
22. März 2017 (online)
Cystectomy is the gold standard treatment for patients with bladder cancer. Urinary diversion with ileal conduit and uretero-ileal anastomoses, as described by Bricker, is the most widely used surgical therapy because of the lower risk of postoperative complications in elderly patients and in those with co-morbidities. The Bricker technique involves the use of a segment of the ileum as a conduit to the skin, with a successive uretero-ileal-cutaneous anastomosis for each ureter [1]. The endoscopic approach to construction of the ileal conduit for urological obstruction is rarely reported [2]. We present the case of a patient who underwent cystectomy with a Bricker uretero-ileal-cutaneous anastomosis, who developed a fistula between the ileal conduit and an ileal handle.
In May 2015, the patient underwent cystectomy with a Bricker uretero-ileal-cutaneous anastomosis because of bladder transitional cell carcinoma. In October 2016, stool appeared in the drainage. The patient underwent radiological examination with contrast medium at another hospital, which revealed a fistula between the ileal conduit and an ileal handle. The patient was referred to our unit and an ileal conduit endoscopy ([Fig. 1]) was performed using a gastroscope, which showed stool leakage from an orifice between the two ureteral anastomoses ([Fig. 2]). An 11/6 traumatic-teeth over-the-scope clip (OTSC), 9 mm in diameter, was placed to close the leak ([Video 1]), using an OTSC anchor to grasp the fistula ([Fig. 3]). Stool no longer appeared in the drainage 24 hours after OTSC placement. No adverse events occurred, and the patient was discharged 3 days after the procedure.
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Qualität:
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There are no reports in the literature of the endoscopic closure of a fistula between the ileal conduit and an ileal handle. The current case demonstrates successful closure using an OTSC, which avoided damage to the uretero-ileal anastomoses. The OTSC is an excellent endoscopic therapeutic and conservative option in this particular and rare adverse event.
Endoscopy_UCTN_Code_TTT_1AQ_2AG
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Competing interests
None
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References
- 1 Bricker EM. Substitution for the urinary bladder by use of isolated ileal segments. Surg Clin North Am 1956; 36: 1117-1128
- 2 Mangiavillano B, Montanari E, Santoro T. et al. Double endoscopic retrograde ureteral drainage performed with a standard gastroscope in a cystectomized patient with a Wallace ureteroilealcutaneous anastomosis. Dig Liver Dis 2012; 44: 624-625
Corresponding author
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References
- 1 Bricker EM. Substitution for the urinary bladder by use of isolated ileal segments. Surg Clin North Am 1956; 36: 1117-1128
- 2 Mangiavillano B, Montanari E, Santoro T. et al. Double endoscopic retrograde ureteral drainage performed with a standard gastroscope in a cystectomized patient with a Wallace ureteroilealcutaneous anastomosis. Dig Liver Dis 2012; 44: 624-625
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0043-103403-i0052cl1.jpg)
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![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0043-103403-i0052cl2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
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![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)