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


METHODS
Physical examination, urine culture, urine cytology, peripheral smear, complete blood count, loopogram, CT-intravenous pyelogram, loop endoscopy, bilateral ureteroscopy, liver function tests, CT angiography, (99m)Tc-tagged red cell scan, hepatitis panel, measurement of transjugular wedge pressure, transjugular liver biopsy with pathologic analysis and re-evaluation of CT angiogram.


METHODS
Hematuria secondary to portal hypertension.


RESULTS
The patient initially underwent revision of the ureteroileal anastomosis on the basis of the results of the (99m)Tc-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.
Tu
William H
WH
Department of Urology, Stanford University School of Medicine, Stanford, CA 94305-5118, USA.
Chao
Debbie
D
Gill
Harcharan
H
D000368:Aged; D003937:Diagnosis, Differential; D006417:Hematuria / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D008297:Male; D014547:Urinary Diversion / Q000009:adverse effects*