Ileal Conduit Necrosis Secondary to Spontaneous Retroperitoneal Hematoma

Abstract

Case Presentation: A fifty-nine years old woman with previous muscle-invasive bladder cancer treated five years prior in another medical center with radical cystectomy and Bricker’s ureteroileostomy diversion, presented to the Emergency Room (ER) describing general discomfort, diarrhea, arterial hypotension and tachycardia. After conducting an imaging test, ileal conduit ischemia and mesenteric ischemia was diagnosed secondary to retroperitoneal hematoma. Ileal reservoir resection, resection of the ischemic intestine, and bilateral cutaneous ureterostomy were performed.

Relevance: In patients with previous urinary diversion and acute abdominal pain, it is imperative to dismiss conduit involvement.

Clinical Implications: In cases of acute abdomen with history of urinary diversion, physical examination and imaging tests can detect if the ileal reservoir has been compromised and, therefore, guide the adequate therapeutic approach.

Conclusions: Identifying the complications of the urinary diversion in early stages in order to treat the underlying cause is advisable.