Ileal Segment Research Articles

Reconstruction of Pharyngolaryngeal Defects with the Ileocolon Free Flap: A Comprehensive Review and How to Optimize Outcomes.

Several reconstructive methods have been reported to restore the continuity of the aerodigestive tract following resection of pharyngeal and hypopharyngeal cancers. However, high complication rates have been reported after voice prosthesis insertion. In this setting, the ileocolon free flap (ICFF) offers a tubularized flap for reconstruction of the hypopharynx while providing a natural phonation tube. Herein, we systematically reviewed the current evidence on the use of the ICFF for reconstruction of the aerodigestive tract. A systematic literature search was conducted across PubMed MEDLINE, Web of Science, ScienceDirect, Scopus, and Ovid MEDLINE(R). Data on the technical considerations and surgical and functional outcomes were extracted. Twenty-one studies were included. The mean age and follow-up were 54.65 years and 24.72 months, respectively. An isoperistaltic or antiperistaltic standard ICFF, patch flap, or chimeric seromuscular-ICFF can be used depending on the patients' needs. The seromuscular chimeric flap is useful to augment the closure of the distal anastomotic site. The maximum phonation time, frequency, and sound pressure level (dB) were higher with ileal segments of 7 to 15 cm. The incidence of postoperative leakage ranged from 0 to 13.3%, and the majority was occurring at the coloesophageal junction. The revision rate of the microanastomosis ranged from 0 to 16.6%. The ICFF provides a reliable and versatile alternative for reconstruction of middle-size defects of the aerodigestive tract. Its three-dimensional configuration and functional anatomy encourage early speech and deglutition without a prosthetic valve and minimal donor-site morbidity.

MESENTERIC MECKEL'S DIVERTICULUM WITH PATENT URACHUS – A RARE ASSOCIATION

Background: The association of the three anomalies, i.e., mesenteric Meckel's diverticulum, persistent vitelline artery and patent urachus has never been reported previously. Case presentation: A six-month-old infant presented with the complaint of clear uid discharge from umbilicus since birth. With a pre-operative diagnosis of patent urachus, he underwent laparoscopy, which documented additional ndings of persistent vitelline artery and mesenteric Meckel's diverticulum. Resection of the ileal segment with mesenteric Meckel's diverticulum and end to end anastomosis was done. Patent urachus with bladder cuff was excised, and bladder was repaired. The postoperative recovery was uneventful, and the child is doing well on follow-up. The case highlights the importance of laparoscopy in diagnosis of mesenteric Meckel's diverticulumConclusion: with patent urachus and persistent vitelline artery.

MP25-16 CLINICAL IMPLICATIONS OF THE URINARY DIVERSION MICROBIOME AFTER RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 May 2022MP25-16 CLINICAL IMPLICATIONS OF THE URINARY DIVERSION MICROBIOME AFTER RADICAL CYSTECTOMY Saum Ghodoussipour, Seyedeh Sanam Ladi Seyedian, David Nusbaum, Shane Pearce, Hiren Patel, Aishani Prem, Wendy Ullmer, Sumeet Bhanvadia, Hooman Djaladat, Anne Schuckman, Gangning Liang, and Siamak Daneshmand Saum GhodoussipourSaum Ghodoussipour More articles by this author , Seyedeh Sanam Ladi SeyedianSeyedeh Sanam Ladi Seyedian More articles by this author , David NusbaumDavid Nusbaum More articles by this author , Shane PearceShane Pearce More articles by this author , Hiren PatelHiren Patel More articles by this author , Aishani PremAishani Prem More articles by this author , Wendy UllmerWendy Ullmer More articles by this author , Sumeet BhanvadiaSumeet Bhanvadia More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , Gangning LiangGangning Liang More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002568.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We use bacterial 16S rRNA and fungal ITS sequencing to identify the UD microbiome after radical and clinical implications of taxonomic and microbial diversity differences. METHODS: We enrolled patients who underwent RC and UD with either ileal conduit or neobladder under an IRB-approved protocol. A catheterized urine specimen from the native bladder and a swab of the ileal segment used to create the UD were collected in the operating room. We then collected sequential catheterized specimens from the UD until 1-year after surgery. Preoperative antibiotic prophylaxis was administered according to an institutional ERAS protocol. Microbial 16S rRNA and ITS sequencing and profiling were performed. RESULTS: We included 20 patients (75% male, 30% had neoadjuvant chemotherapy). The 90-day complication rate was 60% (n=12), including infectious in 25% (n=5). The average bacterial count, estimated by gene copy number, was higher in the bowel swab (1.38 x 108 cells/ml) than native bladder (7.23 x 106 cells/ml) as was alpha diversity, which measures the number of different species in each sample (mean species richness = 50 ± 26 in bowel and 29 ± 25 in native bladder). The average UD bacterial count and alpha diversity was high on post-operative day 1 (1.38 x 108 cells/ml and 31 ± 19, respectively), but over time, alpha diversity decreased while bacterial counts tended to increase (11 ± 12 and 4.54 x 108 cells/ml at 1 year, respectively). High fungal cell counts (>1,000 cells/ml) were noted in 7 patients and Candida species were abundant in all but one. Principal coordinate analysis showed microbial profiles of the native bladder and ileum clustering in distinct patterns, but the UD microbiome varied between patients (Figure). Age, gender, receipt of neoadjuvant chemotherapy and type of diversion did not predict similarities in the UD microbiome. There were no significant differences in microbial diversity or bacterial count amongst patients with and without complications. However, a high fungal count was associated with any complication in the first month (p<0.01) and first year (p<0.05). CONCLUSIONS: The UD microbiome differs from the native bladder and ileum and varies widely between patients. High fungal loads are associated with patients having any complication, potentially implicating Candida species as a pathogenic organism. Source of Funding: Zymo Research Corp © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e434 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Saum Ghodoussipour More articles by this author Seyedeh Sanam Ladi Seyedian More articles by this author David Nusbaum More articles by this author Shane Pearce More articles by this author Hiren Patel More articles by this author Aishani Prem More articles by this author Wendy Ullmer More articles by this author Sumeet Bhanvadia More articles by this author Hooman Djaladat More articles by this author Anne Schuckman More articles by this author Gangning Liang More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement PDF DownloadLoading ...

Protective Effects of Hydrogen-Rich Saline on Experimental Intestinal Volvulus in Rats

Background Intestinal volvulus can cause morbidity and mortality. Surgical reduction, on the other hand, could result in ischemia-reperfusion (I/R) injury. Hydrogen rich saline solution (HRSS neutralizes free radicals in the body. This study aimed to investigate the effects of HRSS in I/R injury in experimental intestinal volvulus in rats. Methods Thirty rats were randomly allocated into 5 groups. All procedures were done under general anesthesia and sterile conditions in each animal. Five ml/kg of saline and HRSS were administered intraperitoneally (ip) in Sham (Group 1) and HRSS (Group 2) groups, respectively. Groups 3, 4, and 5 constituted the study groups in which volvulus was created in a 5-cm- long ileal segment 2 cm proximal to the ileocecal valve. After 2 hours the volvuli were reduced and following 2 hours of reperfusion, these segments were removed. In volvulus-I/R group (Group 3) no additional procedure was done. HRSS was administered shortly before reperfusion (reduction of the volvulus) in Treatment I (Group 4) and 1 h before experimental volvulus in Treatment II (Group 5) groups. Blood and intestinal tissue samples were obtained from all rats at the 4th hour. Both tissue and blood total oxidant (TOS) and antioxidant status (TAS) levels were determined and tissue histomorphologies were studied. Oxidative stress indices (TOS ÷ TAS) (OSI) were calculated. Results Tissue TOS and OSI levels and histomorphological injury scores were statistically lower in treatment groups than I/R group, whereas blood TOS and OSI levels were similar between the groups. Conclusions This study provides biochemical and histomorphological evidence that HRSS prevents intestinal damage in I/R injury caused by volvulus.

Meckel's Diverticulum, A Rare Presentation in a Neonate.

Meckel's diverticulum is commonly symptomatic the first 2years of life. Complications associated with Meckel's diverticulum are due to gastrointestinal (GI) bleeding or obstruction. A 5-day-old male presented to the emergency department (ED) with an episode of bright red blood per rectum (BRBPR) associated with emesis. Vital signs were normal and abdomen soft and non-distended. Serial abdominal radiographs progressed to show distention of small bowel and air fluid levels. Operative intervention was undertaken with diagnosis of intestinal obstruction. On exploratory laparotomy, 24cm of a fibrosed, ischemic closed-loop ileal segment densely adherent to the tip of a Meckel's diverticulum was identified and resected, followed by primary reanastamosis. Histologic findings confirmed ectopic gastric tissue. Symptomatic Meckel's diverticulum is often secondary to intestinal obstruction and hematochezia, findings which are caused by incarcerated inguinal hernia or ileocolic intussusception. Our patient presented with a closed loop, which has not been previously reported.

Confluent Small Bowel Lipomatosis: A Rare Cause of Recurrent Abdominal Pain

Small intestine lipomatosis is rare but may be associated with pain, intussusception, and gastrointestinal bleeding. In this report, we examine the case of a 41-year-old man who had recurrent presentations to the emergency department with non-specific abdominal pain. Preoperative imaging suggested extensive infiltration of small intestine with macroscopic fat. At surgery, extensive and confluent small bowel lipomatosis were seen. The affected ileal segment was resected, and the patient remained symptom-free after surgery. Abdominal lipomatosis is a rare condition which can be completely treated by resection of the affected gut segment but is often unsuspected and difficult to diagnose. In this report, we describe a case with the most extensive lipomatosis on record with more than 70 cm of gut with confluent lipomatosis. Magnetic resonance Enterography (MRE) is a useful non-invasive diagnostic modality, although laparoscopy/laparotomy may be necessary for assessment of the extent of disease. Symptomatic cases should be treated with segmental small bowel resection, which is curative.

P234 Remission state in Inflammatory Bowel Disease patients on anti TNF or vedolizumab: a confocal endomicroscopy study

Abstract Background Confocal endomicroscopy is a technique allowing the in vivo assessment of the superficial layers of the mucosa, including the epithelium, the surrounding connective tissue and blood vessels. Some of the features observed by endomicroscopy can’t be assessed by classical histology. Preliminary studies have already suggested its added value in the assessment of endoscopic remission in IBD. However, most of these studies were performed on patients still having some endoscopic activity. Furthermore, to our knowledge, no study has used endomicroscopy to compare the state of remission in IBD patients under vedolizumab and anti TNF. Our aim was to disclose persisting endomicroscopy anomalies in patients with full endoscopic healing and to compare them between vedolizumab and anti-TNF. Methods we screened patients with CD or UC treated for more than 6 months by adalimumab, infliximab, or vedolizumab, and being in steroid-free clinical (PRO2) and biological remission (CRP&amp;lt;5 mg/l and F Cal &amp;lt;250 microg/g). Confocal endomicroscopy analysis was performed in the ileum, right colon, transverse colon, left colon and rectum. In each ileal segment, we recorded fluorescein leakage, the presence of epithelial erosions, gap junction anomalies and vessel diameter. In each colonic segment, we recorded the presence of fluorescein leakage, crypt dilatation, vessel diameter, and hypervascularization. Patients were prospectively follow-up and clinical relapses (PRO2 + one objective marker) were recorded. Results 72 CD and UC patients treated by biologic therapy and in clinical remission were screened. 37 of them were also in endoscopic remission (eMayo=0 in UC and absence of ulcer or erosion in CD) and were included in our study. Their treatment were infliximab (n=5), adalimumab (n=16), vedolizumab (n=15) and ustekinumab (n=1). We found a persistence of residual endomicroscopy anomalies in the different segments in a substantial number of patients (table 1). These persisting abnormalities were not significantly associated with any demographic or clinical characteristics including the treatment (anti-TNF or vedolizumab), nor with histologic parameters (almost all patients were in histologic remission), levels of CRP or F Cal. The average follow-up time was 33.4 (+/- 9.5) months. Among the 37 patients, 7 (18.9%) relapsed. The risk of relapse was not associated with any clinical, biological, histologic or endomicroscopy factor. Conclusion Despite endoscopic, biological and even histologic remission, we found a high prevalence of endomicroscopic abnormalities, which were not different between anti-TNF and vedolizumab treated patients. The clinical significance of these anomalies remains to be clarified.

The Effects of L-Carnitine on Gastrointestinal Contractility and Histological Changes in Rat Intestinal Ischemia-Reperfusion Injury

Ischemia-reperfusion (I/R) of the small intestine causes serious abdominal pathologies including tissue dysfunction and organ failure. L-carnitine (L-C), a powerful antioxidant, may help lessen the severity of these pathological effects since it plays a key role in energy metabolism. In this work we aimed to study the effects of L-C on the isolated ileal and duodenal contractility and histological changes in intestinal ischemia and reperfusion injury. Twenty eight Wistar rats were divided into four groups. The first group is the control group. Second group, I/R group, had rats submitted to 45-minutes of intestinal ischemia and to 45-minutes reperfusion. The third group, I/R+ L-C group, rats were treated with L-C 5 minutes before reperfusion and than submitted to ischemia. The fourth group, included rats that were treated with L-C without ischemia or reperfusion. Intestinal ischemia was conducted by obstructing superior mesentery arteries by silk loop. The ileal and duodenal segments were isolated and suspended in tissue bath. Contractile responses were induced by acetylcholine (Ach) and relaxation was achieved with phenylephrine. At the same time the terminal ileal and duodenal segments were examined for histological changes. Ach-induced contraction responses were higher in the I/R+L-C group, the L-C group, and the control group compared to the I/R group, in both ileal and duodenal segments. On the other hand, the phenylephrine-induced relaxations were higher in the I/R+L-C and L-C groups, especially in duodenal segments. In I/R group intestinal morphology was observed to be severely damaged whereas in I/R+L-C group the damage was noticeably lower possibly due to protective properties of L-C. I/R injury caused severe cellular damage response within the muscularis resulting in decreased gastrointestinal motility. Treatment with the L-C has significantly affected the gastrointestinal contractility. Also L-C treatment reduced the damage in intestinal morphology that occurs after IR injury.

GASTRIC AND PANCREATIC HETEROTOPIA PRESENTING AS PATHOLOGICAL INTUSSUSCEPTION IN AN ADULT FEMALE

Gastric and pancreatic heterotopias are rare entities. They have been identified throughout the entire length of the gastrointestinal tract and in other structures, including Meckel’s diverticulum and the Ampulla of Vater. However, very few cases of combined gastric and pancreatic heterotopias in ileum have been reported till date. Also, intussusceptions in adults are uncommon. Here we report a novel case of combined gastric and pancreatic heterotopia in ileum in a 32-year-old female. The patient presented with complaints of pain in abdomen and bleeding per rectum. On computed tomography, ileo-ileal intussusception was seen in the distal ileum. Exploratory laparotomy revealed an ileal polyp. The ileal segment with the polyp was resected and sent for histpathological examination. It was diagnosed as heterotopic gastric and pancreatic tissue in ileum. It highlights the importance of histopathological examination for definitive diagnosis of this rare clinical entity.

Hyperplastic polyp of the ileum causing intestinal intussusception

In this study, the management of an adult patient with a mechanical small bowel obstruction caused by intussusception due to hyperplastic polyp is presented. A 25-year-old man presents to the emergency department for abdominal pain accompanied by nausea and vomiting. In the abdominal examination, the patient had sensitivity in all abdominal quadrants. Contrast-enhanced abdominal computed tomography (CT) showed enlargement of the intestinal loops, air-fluid levels, and intertwined intestinal segments in the pelvic region. On exploration with a midline incision, it was observed that the 40-cm ileal segment, starting 70 cm proximal to the ileocecal valve, was invaginated into the distal ileal segment with its mesentery. After 40 cm ileal resection, bowel reconstruction was performed with a side-to-side anastomosis with a linear stapler. The patient was discharged on the seventh postoperative day without any complications. In the histopathological evaluation of the resection material, there was a hyperplastic polyp measuring 20 × 15 mm. According to the pathology result, no additional intervention was considered for the patient.

Human papillomavirus bowel colonization in inflammatory bowel disease: A comparative case control study.

ABSTRACTBackground and Aims:Although much of the research on the plausible environmental triggers for inflammatory bowel disease (IBD) has focused on bacterial pathogens, the relationship between bowel colonization with human papillomavirus (HPV) and IBD has not been previously explored. In this study, we aimed to investigate the association between HPV ileocolonic colonization and IBD.Patients and Methods:We performed a cross-sectional study involving consecutive patients with established IBD who were referred for endoscopic evaluation. During endoscopy, mucosal biopsies were obtained from the most inflamed colonic or ileal segments in cases and from the rectosigmoid region for controls. A hybrid capture assay was used to detect tissue HPV. The prevalence of HPV colonization was determined for cases and controls and was compared using Fisher’s exact test.Results:A total of 201 patients, including 104 patients with IBD and 97 non-IBD controls, were prospectively included. Females comprised 55.5% of the study participants (58% vs. 55.2% for controls, P = 0.94). Fifty-seven (54.8%) patients had ulcerative colitis, and 45 (43.2%) had Crohn’s disease. The mean age was 43.2 +-18.2 years. Endoscopically active disease was documented in 56 cases (56%). HPV colonization was detected in four (4.1% subjects in controls vs. none in the cases, P = 0.05).Conclusions:There was no evidence of HPV ileocolonic colonization in this cohort of patients with IBD, regardless of disease activity. HPV colonization does not appear to be linked to IBD diagnosis or disease severity.

Closed loop intestinal obstruction secondary to Ileo-sigmoid knotting (ISK) – A diagnostic challenge

Intestinal obstruction due to Ileo-sigmoid knotting is a very rare phenomenon associated with high mortality rate leading to bowel gangrene and peritonitis. We present a rare cause of closed loop intestinal obstruction in a 46-year-old male patient who presented to the emergency department with complaints of severe abdominal pain, distension and multiple episodes of vomiting in the past 1 day. Prompt resuscitation and exploratory laparotomy revealed knotting of the sigmoid colon around the mesentery of small intestine with segmental gangrene of both sigmoid colon and small intestine. Resection of the gangrenous ileal segment with end-to-end anastomosis followed by Hartman’s procedure to the gangrenous sigmoid colon was performed. Ileo-sigmoid knotting is a surgical emergency with rapid progression to bowel gangrene and peritonitis leading to sepsis and has a very high mortality. Early diagnosis, fluid resuscitation and prompt surgical intervention are key steps towards management.

A rare case of primary non-metastatic Non-Hodgkin's diffuse large B-cell lymphoma in the ileum in a 19-year-old male manifested as intestinal obstruction- A case report.

Introduction and importanceThe gastrointestinal system is the most common site for extra-nodal NHL. Adolescent population are among the rarest of compromised groups, especially males. The gastrointestinal system is more involved by secondary metastasis rather than by primary lymphomas. Cardinal B-Symptoms and obstipation constituted the presentation of our patient who was diagnosed postoperatively as a case primary non-metastatic NHL. NHL can have misleading presentations which result in the implementation of different treatment modalities. We ought to have high clinical suspicion when presented with a patient suffering from B-Symptoms and obstipation to make timely judgements which help in performing effective therapeutic interventions to limit the morbidity and mortality which result from this pathology.Case presentationWe present the case of a 19-year-old male, who presented with obstipation and B-Symptoms. CT scan indicated loop dilation, a lobulated mass, and what radiologically seemed to be intussusception. Surgery was done and the resected specimens were DLBCL.Clinical discussionWe treated him by surgical excision of the affected ileal segments. Histopathology indicated a primary Non-Hodgkin's DLBCL of the ileum. Afterwards, we referred him for adjuvant chemotherapy. Treatment modalities for this malignancy are mainly surgical in addition to Chemotherapy.ConclusionIntestinal extranodal NHL presents with an array of vague symptoms. As a result, this type of tumors can be clinically indistinguishable from other gastrointestinal malignancies. It is vital to keep this type of malignancy in mind as a differential diagnosis when presented with a surgical abdomen in a patient with B-Symptoms.

Inverted ileal loop prolapse through patent vitellointestinal duct

Patient vitellointestinal duct (VID) is not very common because of its varied presentation and complication, and the prolapse of an inverted ileal loop through patent VID is an extremely rare presentation. Here, we report a case of a 4-month-old boy of patent VID through which distal half of the inverted ileal loop got prolapsed, appearing as Y loop. Emergency laparotomy was done. The ileal loop was reduced and resection anastomosis of the involved ileal segment was performed.

Little Old Lady’s Hernia with Hiatus Hernia- A Case Report

With the outbreak of the Coronavirus Disease-2019 (COVID-19) pandemic, it is not uncommon to see patients who present with respiratory symptoms secondary to an abdominal pathology, being suspected of having COVID-19. Here, authors report a case of an elderly female who presented with recent-onset dyspnoea, shortness of breath, pain abdomen and non passage of flatus and stools. Examination revealed that the patient had tachycardia, tachypnoea, and dyspnoea with an oxygen saturation (SpO2) of 92%. Her abdomen was distended, non tender with no free fluid detected. All the hernial orifices were free. Computed Tomography (CT) scan revealed a left diaphragmatic hernia and a left-sided obturator hernia with obstructed ileal segment. However, intraoperatively a Type IV hiatus hernia was discovered, where the Gastrooesophageal (GE) junction, stomach, colon, and omentum were the contents. This case highlights an unusual clinical presentation of a rare cause of intestinal obstruction and its management during the COVID-19 pandemic. Obstructed obturator hernia is associated with high morbidity and mortality.

Inhibition of SOS Response by Nitric Oxide Donors in Escherichia coli Blocks Toxin Production and Hypermutation.

BackgroundPrevious reports have differed as to whether nitric oxide inhibits or stimulates the SOS response, a bacterial stress response that is often triggered by DNA damage. The SOS response is an important regulator of production of Shiga toxins (Stx) in Shiga-toxigenic E. coli (STEC). In addition, the SOS response is accompanied by hypermutation, which can lead to de novo emergence of antibiotic resistance. We studied these effects in vitro as well as in vivo.ResultsNitric oxide donors inhibited induction of the SOS response by classical inducers such as mitomycin C, ciprofloxacin, and zidovudine, as measured by assays for E. coli RecA. Nitric oxide donors also inhibited Stx toxin protein production as well as stx2 RNA in vitro and in vivo. In vivo experiments were performed with ligated ileal segments in the rabbit using a 20 h infection. The NO donor S-nitroso-acetylpenicillamine (SNAP) reduced hypermutation in vitro and in vivo, as measured by emergence of rifampin resistance. SNAP blocked the ability of the RecA protein to bind to single-stranded DNA in an electrophoretic mobility shift assay (EMSA) in vitro, an early event in the SOS response. The inhibitory effects of SNAP were additive with those of zinc acetate.ConclusionsNitric oxide donors blocked the initiation step of the SOS response. Downstream effects of this blockade included inhibition of Stx production and of hypermutation. Infection of rabbit loops with STEC resulted in a downregulation, rather than stimulation, of nitric oxide host defenses at 20 h of infection.

Hemi-Kock Continent Stoma With Augmentation Cystoplasty: Modifications and Outcomes

ObjectiveTo evaluate the long-term outcomes and impact of surgical modifications on the need for secondary surgery of the Hemi-Kock continent catheterizable stoma, comprising a detubularized ileal segment with an attached stapled ileoileal intussusception of the catheterizable channel, in patients with complex lower urinary tract disorders. The technique may be used for augmentation in patients with reduced bladder capacity who require a continent catheterizable channel. Compared to the flap and ileocecal valve procedures, the hemi-Kock technique has not been widely adopted. Materials and MethodsThis is a retrospective case series including all patients who underwent a hemi-Kock catheterizable channel with cystoplasty from a single institution. Surgical technique and modifications in valve construction and tapering of the catheterizable limb are described. ResultsA total of 109 patients, with a median age of 38 years (range 18-72), underwent the procedure. At a mean of 10.4 years, 98 patients (90%) reported that they were managing with clean intermittent catheterization ± pads; 11 (10%) were failures. A total of 70 (64.2%) patients underwent secondary interventions with >60% performed endoscopically or under local anesthesia, mainly for bladder stones. Fourteen patients (12.8%) required valve revisions. However, the rate decreased from 18.2% (8/44) to 9.3% (6/65) following incorporation of the surgical modifications. ConclusionWe present the largest cohort to date of patients managed with a Hemi-Kock catheterizable channel and cystoplasty. Valve revision rate improved with surgical modifications. We demonstrate long-term durability and maintenance of stomal catheterization in the vast majority of patients.

Single ileal segment in a cat-tail configuration for bilateral ureteric strictures.

Introduction:Management of bilateral long length ureteric strictures is difficult with few options for reconstruction. In this report, we describe our experience with the use of a single, 15- 20 cm ileal segment for reconstruction of bilateral long length (involving more than 2/3rd ureter) ureteric strictures.Patients and Methods:A retrospective analysis of 5 cases operated between 2015 and 2020for bilateral long length ureteric strictures, using a single segment ileal interposition in a cat tail configuration was performed. We evaluated renal function, surgical success, incidence of urinary tract infection and complications of the procedure. Surgical success was defined as an asymptomatic patient with no hydronephrosis and/or prompt drainage of the kidney on radiological investigations.Results:The average age of presentation was 42.8 ± 7.4 years (33-53) years). All the cases were secondary to a gynaecological intervention. The mean creatinine prior to surgery was 0.81 ± 0.36 mg % (range 0.5 -1.4 mg%). Mean duration of follow-up was 28.6 ± 20.6 months (Range 10 – 56 months). Mean hospital stay was 14.4 ± 3.36 days (range 12-20 days). Two patients developed ileus and one patient developed deep venous thrombosis in the post-operative period. One patient developed pyelonephritis within one month of surgery. There was no deterioration of renal function with the mean serum creatinine at last follow-up being 0.9 ± 0.36 mg% (range 0.6 – 1.5 mg%).Conclusion:The use of an ileal segment in cat-tail configuration for bilateral simultaneous ileal replacement is a feasible and safe option. The medium-term result states that it is effective in the preservation of renal function and provides a good conduit for drainage.

Modification of the Indiana Pouch Ileo-Caecal Cutaneous Continent Urinary Diversion: Tubular Ileal Afferent Limb for Ureteral Anastomosis Has Low Stricture Rate and Allows Ileal Ureter Replacement

Objective: The aim of the study was to introduce our new modification of the Indiana pouch with a refluxing ureteral anastomosis in a tubular afferent ileal segment of the ileo-caecal urinary reservoir. Patients and Methods: Between February 2008 and December 2020, we performed a total of 37 modified continent ileo-caecal pouches for urinary diversion when orthotopic bladder substitution was not possible. Hereby, we modified the Indiana pouch procedure with a new refluxing end-to-end ureteral anastomosis into an 8-cm afferent tubular ileal segment. Results: We performed the modified Indiana pouch in 27 women (73%) and 10 men (27%). The median age of the patients at time of operation was 64 years (43–80 years). To date, the average follow-up is 69 months (3–156 months). In 32/37 cases, we performed the new pouch procedure after radical cystectomy for muscle-invasive bladder cancer and in 1/37 cases after radical cystectomy for locally advanced prostate cancer. In 4 cases, the procedure was performed after total exenteration of the pelvis due to locally advanced bladder, colorectal, or gynaecological cancers. Ureteral anastomotic strictures were seen in 2/37 patients (5.4%) or 2/72 (2.8%) of renal units. Conclusions: Our modification of the Indiana pouch cutaneous continent urinary diversion with the ureteral anastomosis to a tubular segment of the pouch is easy to perform and effective in reducing the rate of ureteral anastomotic strictures. By lengthening, the afferent tubular ileal segment, it additionally allows easy ureteral replacement.

Terminal Ileitis: A Rare Complication of Henoch-Schönlein Purpura in Children

Henoch–Schönlein purpura (HSP) is characterized by nonthrombocytopenic palpable purpura, arthritis or arthral­gia, and gastrointestinal and/or renal involvement. Gastrointestinal symptoms are reported in 50%-75% and they are related to a previous group A streptococcal infection in 40%. A healthy 5-year-old girl presented with a three-week history of a recurrent purpuric rash on the lower limbs, ar­thralgia and angioedema, without renal involvement. During the third relapse, she had severe, diffuse and persistent abdominal pain and bloody stools. An abdominal ultrasound revealed transmural edema of the last ileal segment, compatible with ileitis. She received prednisolone for five days, with full clinical recovery. Antistreptolysin O titer was elevated. The remaining laboratory tests were normal (antinuclear, anti-neutrophil and anti-Saccharomyces cerevisiae antibodies; rheumatoid factor; stool cultures, parasitological examination and viral antigen tests). One month later, an abdominal ultrasound revealed no abnormalities. Terminal ileitis is a very rare complication of HSP in children but has a good prognosis.