Endoscopy 2017; 49(S 01): E125-E126
DOI: 10.1055/s-0043-103403
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© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic closure of a fistula between an ileal conduit and an ileal handle localized between two uretero-ileal anastomoses

Benedetto Mangiavillano
1  Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy
,
Mario Bianchetti
1  Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy
,
Loretta Amato
1  Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy
,
Sara Melegari
2  Urology Unit, Humanitas Mater Domini, Castellanza, Italy
,
Mauro Seveso
2  Urology Unit, Humanitas Mater Domini, Castellanza, Italy
,
Gianluigi Taverna
2  Urology Unit, Humanitas Mater Domini, Castellanza, Italy
,
Alessandro Repici
3  Digestive Endoscopy Unit, Istituto Clinico Humanitas Research Hospital, Milan, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
22 March 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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Fig. 1 Endoscopic view of the ileal conduit.
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Fig. 2 Endoscopic view of the fistula (c) between the right (a) and left (b) uretero-ileal anastomoses.
Video 1: Placement of an over-the-scope clip to seal the fistula between the ileal conduit and an ileal handle, which was located between the two ureteral anastomoses.

Quality:
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Fig. 3 An over-the-scope clip was deployed to close the leak.

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.

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