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首页> 外文期刊>Nature clinical practice:Urology >Gross hematuria from an ileal conduit as a first presentation of portal hypertension.
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Gross hematuria from an ileal conduit as a first presentation of portal hypertension.

机译：来自回肠导管的严重血尿是门静脉高压症的首次表现。

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BACKGROUND: A 76-year-old man who underwent cystoprostatectomy with ileal conduit urinary diversion for muscle-invasive bladder cancer presented to his urologist 4 years later with episodes of spontaneous gross hematuria filling his ostomy bag with fresh clots. INVESTIGATIONS: Physical examination, urine culture, urine cytology, peripheral smear, complete blood count, loopogram, CT-intravenous pyelogram, loop endoscopy, bilateral ureteroscopy, liver function tests, CT angiography, (99m)Tc-tagged red cell scan, hepatitis panel, measurement of transjugular wedge pressure, transjugular liver biopsy with pathologic analysis and re-evaluation of CT angiogram. DIAGNOSIS: Hematuria secondary to portal hypertension. MANAGEMENT: The patient initially underwent revision of the ureteroileal anastomosis on the basis of the results of the (99m)Tc-tagged red cell scan, but hematuria recurred 9 months later. Once the hepatology service identified portal hypertension, the patient was taken to the operating room for ligation of a large venous communication between the ileal conduit and a branch of the inferior epigastric vein. He recovered well and was asymptomatic for 8 months. He was followed up by the hepatology service for his newly diagnosed portal hypertension secondary to cirrhosis.
机译：背景：76岁的一名男子因膀胱浸润性膀胱癌接受了膀胱前列腺切除术并回肠导尿管改道，并于4年后向泌尿科医生提出了自发性全血尿的发作，并在他的造口术袋中充满了新鲜的血块。调查：体格检查，尿液培养，尿液细胞学检查，外周涂片检查，全血细胞计数，心电图，CT静脉肾盂造影，环内镜检查，双侧输尿管镜检查，肝功能检查，CT血管造影，（99m）Tc标记红细胞扫描，肝炎检查，经颈静脉楔形压的测量，经颈静脉肝穿刺活检的病理分析和CT血管造影的重新评估。诊断：继发于门脉高压的血尿。处理：根据（99m）Tc标记的红细胞扫描结果，患者最初接受了输尿管油吻合术的翻修，但血尿在9个月后复发。肝病服务部门确定门静脉高压症后，将患者带至手术室，以结扎回肠导管与上epi下静脉分支之间的大静脉连通。他恢复良好，无症状8个月。他因新诊断为肝硬化继发性门静脉高压症而接受肝病服务随访。

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