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Ileal conduit stomal hemorrhage as the fi rst presentation of end stage liver disease: case report and review of the literature

Luke T. Lavallée ¹, Greg Trottier ², Greg Bailly ²

1 Department of Urology, University of Ottawa, Ottawa, Ontario, Canada
2 Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
Address correspondence to Dr. Luke T. Lavallée, Department of Urology, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9 Canada

Canadian Journal of Urology 2009, 16(5), 4863-4865.

Abstract

Hemorrhage from an ileal conduit is a rare and potentially life threatening event with only 17 cases reported in the medical literature. We present the unique case of an 83-year-old patient with acute stomal hemorrhage as the fi rst sign of underlying liver disease and portal hypertension. Bleeding was controlled with conservative measures including balloon tamponade, betablockade, octreotide, and suture ligation. Our review of the literature revealed multiple management options for stomal hemorrhage with most authors advocating defi nitive management via portosystemic shunt creation, either surgically, or with transjugular intrahepatic portosystemic shunt (TIPS). In all cases the incidence of rebleeding associated with the procedure, and the ability of the patient to undergo invasive procedures, must be considered carefully.

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