British Journal of Urology (1975), 47, 630 0
Short Case Report
Haemorrhage from Stoma1 Varices in an Ileal Conduit A case of “caput medusae” developing in an ileal conduit is reported.
References BLOOR,K. and ORR,W. ( I 961). A case of haemorrhage from varices in the small intestine due to portal hypertension. British Journal o/’ S w g e r j ~ ,48, 423-424. HAMLYN,A. N., LUNZER,M. R., MORRIS,J. S., PURITZ,H. and DICK,R. (1974). Portal hypertension with varices in unusual sites. Larrcrt ii, 1531-1534. J. A . and COOK, W. T. (1969). EADE,M. N., WILLIAMS, Bleeding from an ileostomy captit medusaeLancet, ii, 1166-1168.
Case Report A 72-year-old ex-army officer underwent total cystectomy with urinary diversion into a n ileal loop (Wallace “69” Technique) for bladder carcinoma. 2 years later, he was admitted with haemorrhage from the stoma amounting to 500 ml. He gave a history of intermittent minor blood loss for about 3 months. Examination failed to reveal a cause for the bleeding. 1nt ravenous pyelography and a loopogram were normal. The haemorrhage settled spontaneously. He was readmitted 4 months later with severe bleeding. Dilated veins of the anterior abdominal wall were noted for the first time. Haemoglobin was 4.9 gm%. Following transfusion, the stoma was examined under anaesthetic. At the mucocutaneous junction of the stoma there was a ring of small varicosities up to a maximum of 0.5 cm in diameter (Fig.). The conduit was freed, the terminal part excised and the stoma refashioned. Postoperatively, he developed chest complications and uraeinia and died. Postmortem examination confirmed cirrhosis. There was no recurrent carcinoma nor evidence of oesophageal varices.
Comment Reports in the literature of bleeding from porto-systemic venous anastomotic vessels around ileostomies are few (Bloor and Orr, 1961 ; Hamlyn eta/., 1974). This would appear to be the first reported from an ileal conduit. It is interesting to note the absence of the oesophageal varices (Eade, Williams and Cooke 1969). Although refashioning of a stoma is a relatively minor surgical procedure, with an ileal conduit there may be only a limited length of bowel available for excision. J. FOULKES and D. M. WALLACE Department of’ Urology, Royal Marsden Hospital, London, SW3
Fig.
630
Short Case Report
Haemorrhage from Stoma1 Varices in an Ileal Conduit A case of “caput medusae” developing in an ileal conduit is reported.
References BLOOR,K. and ORR,W. ( I 961). A case of haemorrhage from varices in the small intestine due to portal hypertension. British Journal o/’ S w g e r j ~ ,48, 423-424. HAMLYN,A. N., LUNZER,M. R., MORRIS,J. S., PURITZ,H. and DICK,R. (1974). Portal hypertension with varices in unusual sites. Larrcrt ii, 1531-1534. J. A . and COOK, W. T. (1969). EADE,M. N., WILLIAMS, Bleeding from an ileostomy captit medusaeLancet, ii, 1166-1168.
Case Report A 72-year-old ex-army officer underwent total cystectomy with urinary diversion into a n ileal loop (Wallace “69” Technique) for bladder carcinoma. 2 years later, he was admitted with haemorrhage from the stoma amounting to 500 ml. He gave a history of intermittent minor blood loss for about 3 months. Examination failed to reveal a cause for the bleeding. 1nt ravenous pyelography and a loopogram were normal. The haemorrhage settled spontaneously. He was readmitted 4 months later with severe bleeding. Dilated veins of the anterior abdominal wall were noted for the first time. Haemoglobin was 4.9 gm%. Following transfusion, the stoma was examined under anaesthetic. At the mucocutaneous junction of the stoma there was a ring of small varicosities up to a maximum of 0.5 cm in diameter (Fig.). The conduit was freed, the terminal part excised and the stoma refashioned. Postoperatively, he developed chest complications and uraeinia and died. Postmortem examination confirmed cirrhosis. There was no recurrent carcinoma nor evidence of oesophageal varices.
Comment Reports in the literature of bleeding from porto-systemic venous anastomotic vessels around ileostomies are few (Bloor and Orr, 1961 ; Hamlyn eta/., 1974). This would appear to be the first reported from an ileal conduit. It is interesting to note the absence of the oesophageal varices (Eade, Williams and Cooke 1969). Although refashioning of a stoma is a relatively minor surgical procedure, with an ileal conduit there may be only a limited length of bowel available for excision. J. FOULKES and D. M. WALLACE Department of’ Urology, Royal Marsden Hospital, London, SW3
Fig.
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