罕見膀胱內異物:大腸膀胱廔管併膀胱內大腸支架移行
唐靖1 陳雨農2 宋詠娟3 李翊維1 洪健哲1 蔡樹衛1
國泰綜合醫院 外科部 泌尿科1 大腸直腸外科2
國泰綜合醫院 內科部 血液腫瘤科3
Colovesical fistula with intravesical colonic stent migration
Chin Tang1, Yu-Nung Chen2, Yung-Chuan Sung3, Yi-Wei Lee1, Chien-Che Hung1, Shu-Wei Tsai1
Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
Division of Colorectal surgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
Division of Oncology, Department of Internal medicine, Cathay General Hospital, Taipei, Taiwan
Abstract
We present a case of a 65-year-old female with no past medical history presented to our emergency department with a chief complaint of abdominal pain for 3 day. Abdominal and pelvic computer tomography (CT) was done at the ER, which revealed a 5.5cm lobulated tumor in recto-sigmoid colon, invading into bladder and cervix, and causing obstruction of colon with marked dilatation. Colonoscopic biopsy confirmed the tumor as colon adenocarcinoma and the initial clinical staging was ccT4aN2bM1c. To relieve the acute symptoms and high-pressure status, a 10cm metallic colonic stent was inserted though the stenosis site under endoscopic and fluoroscopic guidance. The patient then received neoadjuvant chemotherapy with FOLFIRI and Avastin. However, during the course of the treatment, the patient started to complain dysuria and burning sensation while urination. Follow-up abdominal CT 3 months after the initial chemotherapy showed regression of the primary tumor, but an unusual high radiopaque shadow within the bladder was accidentally discovered as well. Cystoscopy showed the metallic colonic stent penetrating through the erosion of the posterior bladder wall, and colovesical fistula with intravesical colonic stent migration was diagnosed. The patient later received total pelvic exenteration and the colonic stent was successfully removed.
The majority of colonic stents are placed to relieve obstruction caused by malignancy. Migration represent one of its complication but intravesical migration is extremely rare with only a few cases reported in the literature. We present this case to share our experience of diagnosis and management of this peculiar disease.