Placement of an ileal loop urinary diversion back in continuity with the intestinal tract

The use of ileum from a previously constructed urinary conduit for lengthening the small bowel has not been previously reported. We describe a patient with the short-bowel syndrome from previous small-bowel resections, radiation enteritis, and an ileal urinary diversion. The ileal conduit was revised because of recurrent hyperammonemic encephalopathy and apparent stricture of the ureteroenteric anastomosis. In an attempt to increase intestinal length, the ileal conduit was replaced by a colon conduit and the ileum was placed back in continuity with the intestinal tract. The patient had an uneventful recovery, and her chronic diarrhea, nutritional deficiencies, and metabolic derangements resolved. The ileal loop segment regained a normal intestinal appearance on radiographic studies. We suggest that when revision of an ileal urinary diversion is required restoration of the ileum into the intestinal tract may be of particular benefit to patients with the short-bowel syndrome.