Meckel’s Diverticulum As The Site Of Implanting Ureter To The Bricker Segment After Radical Cystectomy

Abstract

A 56-year-old man with stage T2N0M0 grade III bladder cancer diagnosed by computerized tomography and transurethral biopsy underwent cystoprostatectomy. Glomerular filtration rate was 40 to 50 ml. per minute and serum creatinine level was less than 120 mol./l. The upper urinary tract was evaluated by excretory urography. Orthotopic ileal Studer neobladder was elected. At operation the peritoneal cavity was opened, and revealed short and fatty ileal mesentery and post-inflammatory bowel with mesenteric adhesions, which made the Studer neobladder impossible to perform. During surgery at 60 cm. from Bauhin’s valve an 8 cm. long Meckel’s diverticulum was identified on the antimesenteric side of the ileum (see figure). The Meckel’s diverticulum was examined, and the distal end was cut and histologically evaluated intraoperatively. The ileal loop with Meckel’s diverticulum was chosen as the Bricker loop because of its easy mobilization and convenient location in the near hood of the ureters. The right ureter was implanted to the sidewall of the distal end of the Bricker loop. The left ureter was anastomosed end-to-end using 3-zero running sutures, with the distal end of the Meckel’s diverticulum conveniently located on the antimesenteric side. The anastomosis was easily extraperitonized. The ureteroileal anastomosis was stented using polyethylene introduced through the abdominal stoma and removed on postoperative day 6. No wound infection, dehiscence or ileal obstruction was noted. The postoperative period was uneventful. The patient has been followed for 2 years with excretory urography performed every 6 months, plus urine culture sampling and creatinine level measurements. He tolerates the appliance well and has resumed almost normal activity. No sign of recurrent disease, stoma, anastomotic obstruction, stone formation or renal deterioration has been observed during 2 years of followup.