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An unusual diverticulum adjacent to two large colonic polyps; a case report
John Schembri1, Jonathan Bury2, Lesley Hunt3
1Department of Gastroenterology, Sheffield Teaching Hospitals, Northern General Hospital, Herries Road, Sheffield, S5 7AU, England. john.c.schembri@gmail.com.
BMC Gastroenterology
|June 15, 2018
Summary
Colonic neoplasia can develop decades after ureterosigmoidostomy, even in non-functioning diversions. Long-term colonoscopic surveillance is crucial for patients with ureterosigmoidostomies to detect these rare but serious complications.
Area of Science:
- Urology
- Gastroenterology
- Surgical Oncology
Background:
- Urinary diversions using intestinal segments can lead to adenocarcinoma.
- Ureterosigmoidostomy, an older continent urinary diversion, carries a significant risk of malignancy.
- Long-term surveillance is essential for patients with a history of ureterosigmoidostomy.
Observation:
- A 56-year-old female with congenital bladder exstrophy and a history of ureterosigmoidostomy presented with altered bowel habits and rectal bleeding.
- Colonoscopy revealed large sessile polyps near a diverticulum-like structure.
- The structure was identified as a non-functioning ureterosigmoidostomy from infancy.
Findings:
- The patient developed colonic neoplasia 55 years after ureterosigmoidostomy, representing the longest documented latent period.
- Surgical resection confirmed the polyps and the non-functioning ureterosigmoidostomy.
- This case underscores the potential for delayed malignancy after urinary diversion.
Implications:
- Patients with ureterosigmoidostomies require lifelong colonoscopic surveillance programs.
- Endoscopists must recognize the diverse endoscopic appearances of ureterosigmoidostomy anastomoses.
- Vigilance is necessary even in cases of revisional surgery with preserved ureteric stumps.
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