Answer for BIR CoW 04 Apr 2021
URETEROENTERIC STRICTURE
Findings
• Ileal conduit with ileostomy • Left grade IV hydroureteonephrosis with dilatation of left ureter upto it’s anastomotic site – possibly anastomotic site stricture • Non functioning left kidney noted with no significant contrast excretion noted in left kidney • Normal contrast excretion by right kidney with opacification of ileal conduit noted • Incisional hernia noted • Bladder not visualized – post radical cystectomy
Discussion
ILEAL CONDUIT: • Ileal conduit or Bricker conduit • The conduit is formed from 15-20 cm of ileum. The ureters are anastomosed/spatulated to the upstream loop of ileum and the downstream loop is brought to the skin surface as an ostomy. • Most commonly done after cystectomy for muscle invasive Bladder carcinoma.
Complications of Ileal conduit and need for Imaging
Early complications Anastomotic leak and rupture Post surgical fluid collection— hematoma,urinoma,abscess,lymphocele
Late complications Anastomotic site stricture causing obstruction Calculus formation causing obstruction Tumor recurrence Stricture of the ileal loop(reservoir) itself Urinary tract infection
Findings
• Ileal conduit with ileostomy • Left grade IV hydroureteonephrosis with dilatation of left ureter upto it’s anastomotic site – possibly anastomotic site stricture • Non functioning left kidney noted with no significant contrast excretion noted in left kidney • Normal contrast excretion by right kidney with opacification of ileal conduit noted • Incisional hernia noted • Bladder not visualized – post radical cystectomy
Discussion
ILEAL CONDUIT: • Ileal conduit or Bricker conduit • The conduit is formed from 15-20 cm of ileum. The ureters are anastomosed/spatulated to the upstream loop of ileum and the downstream loop is brought to the skin surface as an ostomy. • Most commonly done after cystectomy for muscle invasive Bladder carcinoma.
Complications of Ileal conduit and need for Imaging
Early complications Anastomotic leak and rupture Post surgical fluid collection— hematoma,urinoma,abscess,lymphocele
Late complications Anastomotic site stricture causing obstruction Calculus formation causing obstruction Tumor recurrence Stricture of the ileal loop(reservoir) itself Urinary tract infection
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!