Tarter T H, Kawachi M H, Wilson T G
Department of Urology, City of Hope National Medical Center, Duarte, California, USA.
J Urol. 1995 Aug;154(2 Pt 1):364-6.
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.
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.
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.
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.
回肠和空肠导管尿流改道患者中曾有肠导管瘘的报道，而在使用Kock袋及其他回肠新膀胱的患者中有肠袋瘘的报道。我们现在报告，肠袋瘘是使用右半结肠进行可控性尿流改道的一种罕见并发症。
回顾过去6年中146例行右半结肠尿流改道患者的病历，发现3例发生肠袋瘘。共有36例患者曾接受过盆腔放疗，其中包括3例发生肠袋瘘的患者。2例患者出现恶心、呕吐和腹痛，1例患者出现腹泻且尿液中有食物颗粒。2例患者存在高氯性代谢性酸中毒，对肠袋进行的X线检查确诊了所有3例病例。
3例患者中有2例通过保守治疗（包括低渣饮食和持续引流肠袋）取得成功，1例患者因瘘管在12周后未闭合而需要手术切除肠袋瘘。
尽管罕见，但对于右半结肠贮尿囊尿流改道后出现胃肠道症状和高氯性代谢性酸中毒的患者，应怀疑有肠袋瘘。最初建议采用保守治疗。
