MECKEL'S DIVERTICULUM AS A CONTINENCE MECHANISM

Construction of abdominal urinary reservoirs became routine for supravesical urinary diversion during the last decade. Fashioning a continence mechanism that is reliable and easy for catheterization is principally important for the successful functioning of intestinal reservoirs. We report a case of construction of an ileal reservoir with Meckel's diverticulum as a continence mechanism, which to our knowledge has not been described previously. CASE REPORT A 54-year-old man with the diagnosis of stage TBNOMX bladder cancer underwent radical cystoprostatectomy with simultaneous construction of a detubularized ileal reservoir at our center. During surgery Meckel's diverticulum was identified 80 cm. from the ileocecal valve on the antimesenteric side of the ileum. It was 7.5 cm. long and approximately 1 cm. in diameter. A detubularized ileal reservoir was fashioned using 50 cm. of ileum 55 cm. from the ileocecal valve. This part of the intestine was isolated and detubularized. After construction of the posterior wall the ureters were implanted into the reservoir using the Turner-Warwick technique1 with additional creation of seroserous tunnels. A valve mechanism was then fashioned from Meckel's diverticulum (see figure). Its tip was excised and a 10F catheter was placed through the diverticulum, which was plicated over the catheter. The anterior wall of the reserAccepted for publication April 3, 1998. voir was constructed and the reservoir was closed, leaving a 16F catheter indwelling. Approximately 3 cm. of mesentery were stripped off of the serosa of Meckel's diverticulum. Diverticulum was folded, placed on the anterior surface of the reservoir and embedded into the serous tunnel created by suturing the reservoir wall above it via seroserous interrupted stitches. An umbilical stoma was constructed using the distal end of Meckel's diverticulum. The reservoir was sutured to the anterior abdominal wall with 4 interrupted stitches placed circumferentially around the stoma. The 16F catheter was brought out through the anterior wall of the reservoir and anterior abdominal wall along with the ureteral stents. Two silicone drains were placed in the abdominal cavity. Convalescence was uneventful. The ureteral stents were removed on day 11, the reservoir catheters on day 13 and both abdominal drains on day 14 postoperatively. At followup 2 years postoperatively there are no signs of recurrent disease, the ileal reservoir holds between 400 and 450 ml., the continence mechanism is competent and the patient performs self-catheterization every 4 to 6 hours without difficulty.