Walter Reed National Military Medical Center Bethesda, MD, United States
Pablo S. Santander, MD1, Jared S. Magee, DO, MPH2, Patrick E. Young, MD, FACG1 1Walter Reed National Military Medical Center, Bethesda, MD; 2Walter Reed National Military Medical Center, Rockville, MD
Introduction: An ileal conduit is a common urinary diversion procedure for patients after cystectomy. Problems with the conduit can arise including ureteroileal anastomotic strictures and conduit stenosis1,2. Ileal conduit strictures are uncommon, occurring in no more than 15% of cases and typically years after conduit creation3. We present a novel case of endoscopic stenting as treatment for an ileal conduit stricture.
Case Description/Methods: A 50-year-old man, with ileocolonic Crohn’s disease status post ileal pouch anal anastomosis ten years prior, and abdominal mucinous adenocarcinoma status post pelvic exenteration with ileal conduit creation one year prior, was referred to gastroenterology for hematuria from his conduit. CT imaging revealed fat stranding surrounding the ileal conduit concerning for recurrent inflammatory disease. Enteroscopy of the ileal conduit showed erythema, tissue friability, and a stricture most likely due to ischemia (1A, 1B).
Over the next month, he developed bilateral ureteral obstruction and hydronephrosis from progression of his ileal conduit stricture. To relieve the obstruction, a 10mm x 60mm fully covered biliary stent was placed and sutured externally to the skin. The stent remained for 48 hours before dislodging. Two weeks later, a fully covered 10mm x 60mm self-expanding metal biliary stent was placed and sutured externally in a more robust manner (1C). The stent remained in place for two months before dislodging. Enteroscopy one week later showed dilation of the conduit stricture (1D). A loopogram by Urology showed improved patency and stricture resolution. He was prescribed daily conduit catheterization to prevent stricture recurrence and has not had additional hematuria or hydronephrosis.
Discussion: Ileal conduits are a common method of urinary diversion in patients with pelvic malignancy. Ischemic strictures, while rare, are the most common intra-conduit complication3. Current management options involve surgery or endoscopic balloon dilatation. Retrograde stenting has not been well explored. Stenting has been described in managing stomal stenosis and ureteroileal anastomosis strictures4,5. Our patient presents a rare situation of an ileal conduit stricture present in the absence of other complications and treated with retrograde stenting. This is a viable option for patients who are poor surgical candidates or as a bridge to definitive treatments.
Figure: Figure 1: A - Endoscopic visualization of ileal conduit stricture, B - Initial loopogram with areas of stenosis, C - Stent placement, D - Repeat loopogram with improved luminal patency
Disclosures: Pablo Santander indicated no relevant financial relationships. Jared Magee indicated no relevant financial relationships. Patrick Young indicated no relevant financial relationships.
Pablo S. Santander, MD1, Jared S. Magee, DO, MPH2, Patrick E. Young, MD, FACG1. P1741 - Bowel Is Bowel: Novel Management of an Ileal Conduit Stricture by Endoscopic Stent Placement, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.