Abstract
Clinical History:
A 49-year-old woman who underwent laparoscopic surgery for sigmoid adenocarcinoma and adjuvant treatment. During follow-up, in 2024, local recurrence was observed at the site of the anastomosis.
Physical Exam:
A firm mass was palpated on rectal examination, impeding advancement of the rectal endoscope.
Diagnosis:
In the extension study, CT and MRI scans showed local recurrence in the anastomosis area in contact with both ureters and the right internal iliac artery. This entrapment caused grade II right ureterohydronephrosis.
The case was presented to a multidisciplinary committee, which decided to make a curative surgery followed by intraoperative radiotherapy and reconstruction of the urinary tract.
Intervention:
The procedures begin with bilateral ureteral resection as part of the pelvic exenteration. A 15 cm segment of ileum is selected approximately 40 cm proximal to the ileocecal valve to preserve its function and reduce the risk of malabsorption.
Both ureters are reimplanted into the ends of the ileal segment using a continuous absorbable multifilament suture. Mono-J stents are inserted retrogradely to ensure adequate postoperative drainage.
A longitudinal incision is made along the antimesenteric border of the ileal segment, through which the stents are exteriorized. The bladder is opened to expose the mucosa, and an ileo-vesical anastomosis is performed in two layers (posterior and anterior) with continuous absorbable sutures. The ileal wall is partially embedded into the bladder mucosa, forming a submucosal tunnel with an antireflux mechanism.
Follow-up/Outcomes:
Histopathological analysis of the surgical specimen revealed recurrence of adenocarcinoma without lymph node involvement and clear surgical margins. During follow-up, cystoscopy and cystography showed no signs of urinary leakage.
All authors have received and archived patient consent for video recording/publication in advance of video recording of the procedure.
Author Disclosure Statement:
We do not have any commercial associations during the last 2 years. We do not have any conflict of interest in connection with the video.
Runtime of video: 5 mins.
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