[Intestinal neobladder fistula after radical cystectomy and orthotopic ileal neobladder]

Abstract

Intestinal neobladder fistula is one of the rare complications following radical cystectomy which is described in about 1.5-2% of all patients. We report on 2 of 267 consecutive patients who underwent radical cystectomy with an orthotopic neobladder who developed such a fistula. Both patients presented initially with recurrent urinary tract infections, fever and chills. In both cases the final diagnosis was made after oral intake of poppy seeds. Imaging studies of choice to identify the anatomical localisation of the fistula and to exclude accompanying intra-abdominal fluid collections were made by computed tomography and magnetic resonance imaging. The treatment of choice consists of surgical excision of the fistula, double-layer closure of the neobladder and small bowel resection or double-layer closure depending on the size of the fistula. A conservative approach only seems to be justified in patients with significant comorbidities or very small fistulas without systemic symptoms.