Mechanical bowel obstruction post radical cystectomy: CT-surgical correlation

1. GI14 Mechanical bowel obstruction post radical cystectomy: CT-surgical correlation Mallat F, Hmida W , Hidoussi A, Tlili G, Slama A, Jaidane M, Ben Sorba N, Mosbah AF Ben Abdallah A, Mama N Department of urology and radiology, CHU Sahloul, Sousse Tunisia

2. Radical cystectomy is the preferred standard treatment for patients with muscle-invasive bladder cancer. With improvements in intra- and perioperative care lower complication rates have been reported. We retrospectively evaluated our series of patients who underwent radical cystectomy for advanced bladder cancer for perioperative complications as well as mechanical bowel obstruction Introduction

3. Objectives Determine the sensitivity and the specificity of CT in cases of suspicion of mechanical bowel obstruction post-radical cystectomy by determining its correlation with intraoperative findings

4. Results Study period: 2009-2011 Number of patients: 12 The average age was 66.3 (31–89) Indications for cystectomy: bladder tumor Urinary diversion: Bricker

5. Results • CT has objectified a mechanical obstruction in 12 cases, whereas it was inconclusive in 4 patients • By intraoperative, occlusion was confirmed in 11 patients among the 12 (sensitivity 91%) and 2 of the 4

6. Discussion there is no study that has interested the correlation between CT and surgery in the diagnosis of early intestinal locclusion after cystectomy !

7. Discussion • The rate of postoperative acute occlusion of the small intestine varies between 1.8% and 23.6% • This difference too is that the distinction between paralytic ileus, intestinal transit times of late occlusions and true requiring further surgery is sometimes difficult and is not clearly made in the series in the literature -COHEN S.M., PERSKY L. : A ten-yearexperiencewithuretero-ileostomy. Arch. Surg., 1967 ; 95 : 278-. -DAUGHTRY J.D., SUSAN L.P., STEWART B.H., STRAFFON R.A. : Ileal conduit and cystectomy : a 10-year retrospectivestudy of ileal conduits performed in conjunctionwithcystectomy and with a minimum 5-year follow-up. J. Urol, 1977 ; 118 : 556-557.

8. Discussion • We observed a rate of postoperative intestinal obstruction 12.6%, and a rate of reoperation for occlusion true of 4.1% • The occlusion rate is not unique to the series of trans-ileal cutaneous urétérostomies and is seen in similar proportions after any abdominal surgery intraperitoneally -ESHO J.O., VIKTO R.J., IRELAND G.W., CASS A.S. : Comparison of Bricker and Wallace methods or ureteroilealanastomosis in urinary diversion. J. Urol., 1974 ; 111 : 600-602. -GERBER G.S., KUZNETSOV D., LEEF J.A., ROSENBLUM J.D., STEINBERG G.D. : Holmium : YAG laser endoureterotomy in the treatment of ureteroentericstricturesfollowingorthotopicurinary diversion. Rech. Urol., 1999 ; 5 : 45-48.

9. Discussion Study of Jean-FrancoisHétet:Complications of cutaneous urétérostomies trans-ilealBricker. Analysis of 246 patients: • Intestinal obstruction complicating the postoperative of 31 patients (12.6%) • In 21 cases (8.5%) there was a paralytic ileus or delayed recovery of bowel function with a simple way under suction digestive • whereas in 10 cases (4.1%), the evolution to acute occlusion of the small intestine has real need further surgery. Complications des urétérostomies cutanées trans-iléales selon Bricker. Analyse d'une série de 246 patients, Jean-François Hétet (1), Jérôme RIGAUD (1), Georges KARAM (1), Pascal GLEMAIN (1), Loic LE NORMAND (1), Olivier BOUCHOT (1), Jean-Claude LE NEEL (2), Jean-Marie BUZELIN (1) (1) Clinique Urologique, (2) Clinique Chirurgicale A, CHU Hôtel-Dieu, Nantes, France ProgUrol, 2005, 15, 1, 23-29

10. Discussion Otherstudies

11. conclusion CT has a high sensitivity and specificity in the diagnosis and etiology of positive bowel obstruction post-radical cystectomy