Gross hematuria from an ileal conduit as a first presentation of portal hypertension

Autor: Debbie Chao, Harcharan Gill, William H Tu
Rok vydání: 2008
Předmět:
Zdroj: Nature Clinical Practice Urology. 5:569-573
ISSN: 1743-4289
1743-4270
DOI: 10.1038/ncpuro1192
Popis: In this Case Study, Tu et al. report a 76-year-old man who presented repeatedly with bleeding from an ileal conduit, identified as being caused by an isolated varix secondary to portal hypertension. The authors highlight that portal hypertension should be considered in the differential diagnosis of hematuria from an ileal conduit. Background A 76-year-old man who underwent cystoprostatectomy with ileal conduit urinary diversion for muscle-invasive bladder cancer presented to his urologist 4 years later with episodes of spontaneous gross hematuria filling his ostomy bag with fresh clots. Investigations Physical examination, urine culture, urine cytology, peripheral smear, complete blood count, loopogram, CT–intravenous pyelogram, loop endoscopy, bilateral ureteroscopy, liver function tests, CT angiography, 99mTc-tagged red cell scan, hepatitis panel, measurement of transjugular wedge pressure, transjugular liver biopsy with pathologic analysis and re-evaluation of CT angiogram. Diagnosis Hematuria secondary to portal hypertension. Management The patient initially underwent revision of the ureteroileal anastomosis on the basis of the results of the 99mTc-tagged red cell scan, but hematuria recurred 9 months later. Once the hepatology service identified portal hypertension, the patient was taken to the operating room for ligation of a large venous communication between the ileal conduit and a branch of the inferior epigastric vein. He recovered well and was asymptomatic for 8 months. He was followed up by the hepatology service for his newly diagnosed portal hypertension secondary to cirrhosis.
Databáze: OpenAIRE
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