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The double-barreled wet ileostomy: an alternative method for simultaneous urinary and intestinal diversion without intestinal anastomosis after total colectomy and pelvic exenteration.

BACKGROUND: Although the number of cases of locally advanced colorectal cancer related to familial adenomatous polyposis (FAP) has decreased as a result of a better understanding of the disease, the condition still can offer therapeutic challenges. CASE PRESENTATION: We report a case of a rectal tumor with prostate invasion associated with FAP, treated with neoadjuvant radiotherapy and total extended proctocolectomy with cystoprostatectomy. The reconstruction was undertaken with a double-barreled ileostomy with ureteral reimplantation on the distal segment of the ileostomy. Data including surgical aspects, post-operative complications, and outcome were evaluated. CONCLUSION: The double-barreled wet ileostomy is a technically straightforward and safe procedure that is easily executed and may be an alternative to simultaneous diversion in extreme situations. To the best of our knowledge, this is the first description of this procedure in the literature.

Adenocarcinoma↗

Continent ileocolonic urinary reservoirs for filling and lining the post-exenteration pelvis.

Pelvic exenteration has a high complication rate due, in large part, to the extensive raw surfaces and dead space it creates. Numerous techniques have been used to control this space and line these surfaces, but none, to date, has proven to be a reliable solution. We investigated the use of continent ileocolonic urinary reservoirs as a new "flap" to fill and line the pelvis in 17 patients, and found that our historical complication rate of 44% for pelvic exenteration was reduced to 18%. These reservoirs appear to be an improved method of managing the post-exenteration pelvis.

Adult↗