Liau Siong-Seng, Shabeer Usman A
Queen Margaret Hospital, Fife, United Kingdom.
Surg Laparosc Endosc Percutan Tech. 2005 Dec;15(6):378-9. doi: 10.1097/01.sle.0000191629.89376.6e.
Iatrogenic bowel injury is a recognized complication of percutaneous suprapubic cystostomy. In the present report, we describe a case of misplacement of suprapubic catheter into cecum, in which laparoscopic technique was used successfully to identify and treat this condition. A 72-year-old woman with severe multiple sclerosis underwent her fourth change of suprapubic catheter 3 months after initial insertion. At the time of catheter change, the urologist performed a cystoscopy via the suprapubic tract and found feculent material in the presumed bladder. A diagnosis of colovesical fistula was made, and patient was referred to the acute surgical service. Cystogram via suprapubic catheter showed passage of contrast straight into colon in the region of cecum with no evidence of a fistula. Computed tomography of abdomen and pelvis confirmed the position of the catheter in the cecum. At laparoscopy, the cecum was seen to move when tension was applied to the suprapubic catheter, confirming the catheter tip and balloon in the lower pole of cecum. Laparoscopic transection of the cecum above the point of entry of the catheter was performed using an Endo GIA linear stapler. Under laparoscopic visualization, a new suprapubic catheter was inserted into the bladder. Intraoperative bleeding was minimal and the postoperative course was uneventful.
医源性肠损伤是经皮耻骨上膀胱造瘘术公认的并发症。在本报告中，我们描述了一例耻骨上导管误置入盲肠的病例，其中成功地使用腹腔镜技术识别并治疗了这种情况。一名72岁患有严重多发性硬化症的女性在首次插入耻骨上导管3个月后进行了第四次更换。在更换导管时，泌尿科医生经耻骨上通道进行了膀胱镜检查，在假定的膀胱中发现了粪便样物质。诊断为结肠膀胱瘘，患者被转诊至急性外科。经耻骨上导管进行的膀胱造影显示造影剂直接进入盲肠区域的结肠，未发现瘘管迹象。腹部和骨盆的计算机断层扫描证实了导管在盲肠中的位置。在腹腔镜检查中，当对耻骨上导管施加张力时，可以看到盲肠移动，证实导管尖端和球囊位于盲肠下极。使用Endo GIA线性吻合器在导管进入点上方进行腹腔镜下盲肠横断术。在腹腔镜直视下，将一根新的耻骨上导管插入膀胱。术中出血极少，术后过程顺利。
