Vol. 118, October Printed in U.S.k
THE JOURNAL OF UROLOGY
Copyright © 1977 by The Williams & Wilkins Co.
:MID-URETERAL LEAKAGE: AN UNUSUAL COMPLICATION OF ILEAL CONDUIT HAN M. HANAFY From the Harrisburg Medical Center, Harrisburg, Illinois
ABSTRACT
Peritonitis after ureteroileal urinary diversion usually occurs from urinary leakage caused by disruption at the u:reteroileal anastomosis. A case ofleakage localized at the mid ureter is reported. A woman, 74-3423, underwent anterior exenteration for carcinoma of the cervix. Although every precaution was taken at operation, including a watertight ureteroileal anastomosis and peritonealization of the conduit, 4 days after from the hospital the patient was readmitted with the symptoms and signs of generalized peritonitis. A loopogram failed to demonstrate any urinary leakage. An excretory urogram (IVP) under fluoroscopy showed the leakage to be in the mid right ureter (see figure). Exploration revealed generalized peritonitis and an internal hernia (Richter's of a loop of ileum proximal to the anastomosis. There was gangrene and perforation with a localized abscess over the mid third of the right ureter that became necrotic owing to urine leakage. The ileal conduit was intact. Because of the generalized peritonitis with pus covering the entire abdomen the patient underwent right cutaneous ureterostomy and mucous fistula of the descending colon with left ileostomy after the involved bowel was resected. Accepted for publication June 10, 1977.
A, IVP shows intact left ureter with some extravasation of contrast medium above ileal conduit on right side (arrow). B, delayed film reveals right ureter with dye extravasating from middle third (arrow).
679
THE JOURNAL OF UROLOGY
Copyright © 1977 by The Williams & Wilkins Co.
:MID-URETERAL LEAKAGE: AN UNUSUAL COMPLICATION OF ILEAL CONDUIT HAN M. HANAFY From the Harrisburg Medical Center, Harrisburg, Illinois
ABSTRACT
Peritonitis after ureteroileal urinary diversion usually occurs from urinary leakage caused by disruption at the u:reteroileal anastomosis. A case ofleakage localized at the mid ureter is reported. A woman, 74-3423, underwent anterior exenteration for carcinoma of the cervix. Although every precaution was taken at operation, including a watertight ureteroileal anastomosis and peritonealization of the conduit, 4 days after from the hospital the patient was readmitted with the symptoms and signs of generalized peritonitis. A loopogram failed to demonstrate any urinary leakage. An excretory urogram (IVP) under fluoroscopy showed the leakage to be in the mid right ureter (see figure). Exploration revealed generalized peritonitis and an internal hernia (Richter's of a loop of ileum proximal to the anastomosis. There was gangrene and perforation with a localized abscess over the mid third of the right ureter that became necrotic owing to urine leakage. The ileal conduit was intact. Because of the generalized peritonitis with pus covering the entire abdomen the patient underwent right cutaneous ureterostomy and mucous fistula of the descending colon with left ileostomy after the involved bowel was resected. Accepted for publication June 10, 1977.
A, IVP shows intact left ureter with some extravasation of contrast medium above ileal conduit on right side (arrow). B, delayed film reveals right ureter with dye extravasating from middle third (arrow).
679
