Fistula formation between the external iliac artery and ileal conduit following a radical cystoprostatectomy: a rare complication with prewarning signs of haemorrhage

Abstract

A 76-year-old man was admitted with bleeding per-urostomy following a collapse at home. Three weeks prior to the admission, he had undergone a radical cystoprostatectomy and formation of ileal-conduit for an extensive bladder carcinoma. A CT angiogram revealed a possible small source of bleeding within the ileal-conduit itself, which settled with conservative management. However, prior to discharge he developed profuse fresh bleeding from the urostomy, which could not be controlled. The patient underwent an emergency endoscopy of the conduit and laparotomy, which revealed a fistula between the right external iliac artery and the proximal end of the ileal-conduit. The right iliac artery was ligated and an emergency left-to-right femoral-femoral crossover bypass was performed. The right ureter was stented and rediverted through the ileal-conduit and the left ureter was stented at a later date. He unfortunately had a stormy postoperative recovery with further episodes of per-urostomy bleeding and no identified source.

Figure 1

A 3 phase CT angiogram (precontrast, arterial phase and portal venous phase). By comparing with precontrast imaging the ‘wisp’ of contrast extravasation was shown to occur in the arterial phase, which persisted in the portal venous phase. White arrow: (1) contrast extravasation. Red arrow: (2) ureteric stents in the conduit. Blue arrow: (3) external iliac artery.