Presentation
History of neurogenic bladder secondary to spinal cord injury, post bladder augmentation and ileovesicostomy attached to a urostomy bag. Concern for leak at the anastomosis.
Patient Data
On the scout images there is an IVC filter and multiple surgical clips overlying the right lower quadrant.
A cystogram was then performed. 450 ml was introduced into the bladder through a Foley catheter. On opacification of the bladder, a bowel augment is seen on the superior aspect of the urinary bladder. An ileal conduit is anastomosed to the superior aspect of the augmented segment of the urinary bladder. The ileal conduit is normal in appearance, with free drainage of contrast through the cutaneous stoma into a urostomy bag. There was leakage of contrast through the stoma site when approximately 200 ml of contrast was instilled into the bladder.
No vesico-ureteral reflux
Case Discussion
An ileovesicostomy (also known as a "bladder chimney") is an uncommon procedure performed for severe neurogenic bladder.
In this procedure, the superior portion of the bladder is "augmented" with a piece of ileum. The ileum then exits through a urostomy at the skin surface. The urostomy is not continent and empties into a urostomy bag. The ureters and ureteral orifices are not altered in the surgery.
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