T H Tarter1, M H Kawachi, T G Wilson. 1. Department of Urology, City of Hope National Medical Center, Duarte, California, USA.
Abstract
PURPOSE: Entero-conduit fistulas have been reported in patients with ileal and jejunal conduit urinary diversions, and entero-pouch fistulas have been reported in those with Kock pouch and other ileal neobladders. We now report that entero-pouch fistula is a rare complication of continent urinary diversion using the right colon. MATERIALS AND METHODS: A review of the charts of 146 patients who had undergone right colon urinary diversion during the last 6 years revealed that entero-pouch fistula developed in 3. A total of 36 patients had had previous pelvic radiation, including the 3 with entero-pouch fistulas. Two patients presented with nausea, vomiting and abdominal pain, and 1 presented with diarrhea and food particles in the urine. Hyperchloremic metabolic acidosis was present in 2 of the patients and radiography of the pouch confirmed the diagnosis in all 3. RESULTS: Conservative therapy, which included a low residue diet and continuous drainage of the pouch, was successful in 2 of the 3 patients and surgical excision of the entero-pouch fistula was required in 1 since the fistula did not close after 12 weeks. CONCLUSIONS: Although rare, an entero-pouch fistula should be suspected in patients who present with gastrointestinal symptoms and hyperchloremic metabolic acidosis after right colon reservoir urinary diversion. Conservative therapy is recommended initially.
PURPOSE: Entero-conduit fistulas have been reported in patients with ileal and jejunal conduit urinary diversions, and entero-pouch fistulas have been reported in those with Kock pouch and other ileal neobladders. We now report that entero-pouch fistula is a rare complication of continent urinary diversion using the right colon. MATERIALS AND METHODS: A review of the charts of 146 patients who had undergone right colon urinary diversion during the last 6 years revealed that entero-pouch fistula developed in 3. A total of 36 patients had had previous pelvic radiation, including the 3 with entero-pouch fistulas. Two patients presented with nausea, vomiting and abdominal pain, and 1 presented with diarrhea and food particles in the urine. Hyperchloremic metabolic acidosis was present in 2 of the patients and radiography of the pouch confirmed the diagnosis in all 3. RESULTS: Conservative therapy, which included a low residue diet and continuous drainage of the pouch, was successful in 2 of the 3 patients and surgical excision of the entero-pouch fistula was required in 1 since the fistula did not close after 12 weeks. CONCLUSIONS: Although rare, an entero-pouch fistula should be suspected in patients who present with gastrointestinal symptoms and hyperchloremic metabolic acidosis after right colon reservoir urinary diversion. Conservative therapy is recommended initially.