CU 17. Bleeding stomal varices from ileal conduit urinary diversion (3 case reports and review of the literature)

Objective: To improve the understanding of bleeding stomal varices from ileal conduit urinary diversion.

Methods: 3 cases of bleeding stomal varices from ileal conduit urinary diversion were reported. The pathogenic mechanism, clinical features, diagnosis and treatment of this disease were reviewed and discussed with the relevant literature. The 3 patients were all men in middle or old ages. All of them were operated ileal conduit urinary diversion. The stomals were varices and hemorrhage.

Results: The 3 patients' stomals were found varices through physical examination. The stomals were bleeding at times. Their laboratory examinations showed abnormities of liver functions. Their image examinations showed liver cirrhosis and/or liver metastasis. Portal venous hypertension was considered. We sutured the first patient's varices. But the patient's hemorrhage recurred again and again. At last the patient passed away because of the advanced cancer. We compressed the varices when they were bleeding. Meanwhile we protected the liver function from being worse. The stomal stop varices and bleeding when the liver function got well. The third patient's stomal varices were injected sclerosants. The stomal didn't bleed any longer.

Conclusions: An uncommon complication of ileal conduit urinary diversion is bleeding varices at the stoma site. It is usually found in the patients who get portal venous hypertension because of liver cirrhosis or liver metastasis. We should control the liver function and portal venous hypertension of the patient. At the same time we should stop hemorrhage. TIPS is a safe and effect treatment. Sclerotherapy is a optional treatment.