Department of Urology, SMS Medical College, Jaipur , Rajasthan, IndiaIndia
Department of Urology, Lady Hardinge Medical college, Delhi, IndiaIndia
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An incidentally discovered Meckel’s diverticulum while performing radical cystoprostatectomy with neobladder for muscle inva sive carcinoma bladder was utilized as the most dependent part of the pouch for anastomosis with the urethral stump leading to a simple tension free anastomosis with very good post-operative results.
Keywords: Meckel’s diverticulum; Ileal neobladder; Radical cystectomy; Carcinoma bladder
In review of literature, we found a single case report of using a Meckel’s diverticulum for creation of neobladder in which they found short mesoileum. 1 In another case report Meckel’s diverticulum was used for implanting the ureters. 2 It has also been used for ureteric repair and as an alternative conduit for the Mitrofanoff procedure.3,4 Meckel’s diverticulum is the most common congenital malformation of the gastrointestinal tract. 5 It is an embryologic rest of the omphalomesenteric duct, which normally obliterates in the seventh week of gestation. 6 However, it is formed when the intestinal end of the duct remains. Meckel’s diverticulum is normally diagnosed due to a complication, such as a gastrointestinal bleeding in 25 to 50% of the cases or an infection in about 20% of the cases.5 Obstruction, diverticulitis and intussusception are also commonly seen. Symptoms may be due to inflammation and ulceration in a Meckel’s with ectopic gastric or pancreatic tissue. 6 However, older patients are unlikely to have such findings.5 Ileal orthotopic neobladder is considered to be the first choice for a continent urinary diversion after radical cystectomy because ileum can easily be manipulated into the pelvis without tension and we can create a low-pressure reservoir which is capacious and continent.7 Using 40 cm of bowel does not result in any malabsorption or any major bowel dysfunction.8,9 The Meckel’s diverticulum we found incidentally was in a very suitable location, and the tip could be easily mobilized into the pelvis. By using the Meckel’s diverticulum we could easily perform an anastomosis with the urethral stump without undue tension. A sphere-shaped pouch was created above the diverticulum. The ureters were implanted laterally into the pouch. This operative technique enabled us to create a good capacious pouch and to reach the urethra without traction. In our opinion, we can safely use the diverticulum if found in the absence of any inflammatory bowel disease.4 To our knowledge, this is the first report on the elective use of a Meckel’s diverticulum in the formation of an orthotopic neobladder.
We described the elective use of a Meckel’s diverticulum to lengthen the distal part of an orthotopic neobladder which can be used to create a tension free and relatively easy urethal anastmosis if found incidentally. It may be very useful in case of short mesoileum.
The authors have received written informed consent from the patient.
The authors declare that they have no conflicts of interest.