Ureterosigmoidostomy: the development of tumors, diagnosis, and pitfalls

The development of colon carcinoma after ureterosigmoidostomy has not received adequate attention in the radiologic literature. Two patients who had ureterosigmoidostomy and subsequently developed tumors are described. The third case is a patient with a ureterosigmoidostomy and a ureterocele that simulated the appearance of carcinoma in the sigmoid colon. This is the first report of this entity. Ureterosigmoidostomy patients need frequent follow-up studies since their incidence of carcinoma is significant. The use of barium to study the colon in this group of patients is controversial. Barium can potentially reflux into the kidney with fecal material, which can lead to fibrosis and impaired renal function. However, barium reflux up the ureter is usually of no significance except on those rare occasions when intrarenal reflux occurs and inflammatory changes may develop. The diagnosis of tumors in these patients, diagnostic pitfalls, and controversy regarding use of barium enemas in following these patients are discussed.