Diversion Stones  

Oleh:

Wehbe, Edgard ; Hall, Phillip

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The New England Journal of Medicine (keterangan: ada di Proquest) vol. 364 no. 17 (Apr. 2011), page 364:e36.
Topik: Rectal Prolapse; Bladder Exstrophy; Congenital Atrophic Right Kidney
Fulltext: Diversion Stones.jpeg (369.05KB)

Ketersediaan

Perpustakaan FK Nomor Panggil: N08.K.2011.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

A 28-year-old man presented for evaluation of rectal prolapse. He had a history of bladder exstrophy and congenital atrophic right kidney. During childhood, he had undergone left ureterosigmoidostomy, creation of a cecoileal reservoir, and appendicovesicostomy. On the current presentation, innumerable calculi in the right lower quadrant urinary pouch were incidentally detected on computed tomographic imaging of the abdomen and pelvis (Panel A, coronal reconstruction). The patient underwent open cystotomy with removal of more than 200 large and midsize stones composed of calcium phosphate and magnesium ammonium phosphate (Panel B). A 24-hour urine collection showed hypocitraturia, but other results on laboratory testing were normal. Patients with urinary intestinal diversion are at high risk for stone formation. The reasons for this predisposition are poorly understood, but it is partly related to the acidic nature of the fluid in the renal tubule, increased excretion of calcium, urinary infection with urease-producing bacteria, and the presence of foreign bodies such as sutures or staples. Several months later, the patient had a recurrence of urinary stones, and he underwent open cystolitholapaxy and laser lithotripsy.

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