Hiyama Kazuhiro, Kirino Izumi, Fukui Yasuo
Department of Surgery Atago Hospital Kochi Japan.
Clin Case Rep. 2023 Oct 6;11(10):e8019. doi: 10.1002/ccr3.8019. eCollection 2023 Oct.
Interventional endoscopic ultrasound (EUS) is effective not only for biopsy, but also for abscess drainage. We report the first use of EUS to drain inflammation of the bladder and pelvic dead space through the ileal conduit. EUS-guided drainage is effective in treating postoperative abscesses and should be employed more routinely.
The patient was a 77-year-old man with a vesicoureteral fistula. An ileal conduit was placed after abdominoperineal resection and partial bladder resection for local, postoperative recurrence of rectal cancer. During postoperative chemotherapy, the patient developed a high-grade fever and after a thorough examination, he was diagnosed with bladder and pelvic dead-space inflammation. All urine flowed through the ileal conduit, and it was assumed that secretions from the residual bladder and prostate gland had accumulated in the bladder and pelvic cavity, resulting in infection. A transcutaneous drain was inserted through the perineum and the infection was controlled, but it flared up again after the drain was removed. We concluded that long-term drainage was necessary and successfully controlled the infection by placing a plastic stent through the ileal conduit into the bladder and pelvic dead space under ultrasound endoscopy. This is the first report of ultrasound endoscopic drainage of an abscess through the ileal conduit.
介入性内镜超声（EUS）不仅对活检有效，对脓肿引流也有效。我们报告了首例通过回肠造口术使用EUS引流膀胱和盆腔死腔炎症的病例。EUS引导下的引流在治疗术后脓肿方面有效，应更常规地应用。
患者为一名77岁男性，患有膀胱输尿管瘘。因直肠癌局部术后复发，行腹会阴联合切除术及部分膀胱切除术后放置了回肠造口术。术后化疗期间，患者出现高热，经全面检查后，被诊断为膀胱和盆腔死腔炎症。所有尿液均通过回肠造口流出，推测残余膀胱和前列腺的分泌物积聚在膀胱和盆腔内，导致感染。经会阴插入经皮引流管，感染得到控制，但引流管拔除后感染再次发作。我们得出结论，需要长期引流，并通过在超声内镜引导下经回肠造口将塑料支架置入膀胱和盆腔死腔成功控制了感染。这是首例通过回肠造口进行超声内镜脓肿引流的报告。
