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.
Fig. 1 Endoscopic view of the ileal conduit.
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.
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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