Tsai Li-Hsien, Li Wei-Juan, Chen Guang-Heng, Hsieh Po-Fan, Chang Chao-Hsiang
Department of Urology, China Medical University Hospital, North District, Taichung, Taiwan.
Medicine (Baltimore). 2019 Oct;98(41):e17222. doi: 10.1097/MD.0000000000017222.
Radical cystectomy and urinary diversion remains the definite management for muscle invasive bladder urothelial cancer. Internal herniation caused by ureteral adhesion is an extremely rare complication after the procedure. To the best of our knowledge, this is the first case report of small bowel obstruction and internal herniation occurring between bilateral ureters and urinary diversion after robot-assisted radical cystectomy (RARC).
A 64-year-old woman presented with symptom of small bowel obstruction such as nausea, vomiting, and abdominal fullness after RARC and Indiana pouch. Another 61-year-old man presented with left obstructive hydronephrosis and recurrent pyelonephritis after RARC and ileal conduit.
Both patients received computed tomography scans and the results were suggestive of small bowel herniation between bilateral ureters and urinary diversion.
The 2 patients underwent open ureterolysis and internal hernia reduction. During the operation, bowel loop herniation between the interureteral spaces were found.
Both patients recovered smoothly after second operation.
The incidence of internal herniation may increase by the growing use of RARC. Suitable stoma position, appropriate length of ureter dissection, and retroperitonealization can help prevent this complication.
根治性膀胱切除术及尿流改道术仍是肌层浸润性膀胱尿路上皮癌的确定性治疗方法。输尿管粘连导致的内疝是该手术后极为罕见的并发症。据我们所知，这是首例关于机器人辅助根治性膀胱切除术（RARC）后双侧输尿管与尿流改道之间发生小肠梗阻和内疝的病例报告。
一名64岁女性在接受RARC及印第安纳袋手术后出现小肠梗阻症状，如恶心、呕吐和腹胀。另一名61岁男性在接受RARC及回肠代膀胱术后出现左肾梗阻性积水和复发性肾盂肾炎。
两名患者均接受了计算机断层扫描，结果提示双侧输尿管与尿流改道之间存在小肠疝。
两名患者均接受了开放性输尿管松解术及内疝复位术。术中发现输尿管间隙之间存在肠袢疝。
两名患者二次手术后均顺利康复。
随着RARC应用的增加，内疝的发生率可能会上升。合适的造口位置、适当的输尿管游离长度以及腹膜后化有助于预防此并发症。
