Our Summary

This study talks about a unique surgical procedure performed on a 40-year-old man who was suffering from a stubborn urinary tract infection. The doctors found out that he had an abnormal connection (fistula) between his sigmoid colon (part of the large intestine) and bladder, caused by an outpouching (diverticulum) from his sigmoid colon. To treat this, they performed a laparoscopic surgery, which is a minimally invasive surgical procedure.

During such surgeries, there’s often a risk of injuring the ureter (the tube that transfers urine from the kidneys to the bladder), especially in cases of advanced cancer or inflammatory diseases. To prevent this, a ureteral stent (a small, flexible tube) is usually inserted before the surgery. However, in this case, the surgeons used a unique tool called a near-infrared ray catheter (NIRC). This tool glows when exposed to near-infrared light, allowing the surgeons to clearly see and avoid damaging the ureter during the operation.

This method was particularly useful as the patient had a lot of inflammation around the fistula, increasing the risk of damaging the ureter. By using the NIRC, the surgeons were able to safely perform the surgery, preserving the ureter and successfully removing the problematic part of the colon.

FAQs

  1. What was the medical condition diagnosed in the 40-year-old man who visited the hospital?
  2. What surgical procedure was performed on the patient with a sigmoidovesical fistula?
  3. How does the use of a near-infrared ray catheter (NIRC) help in performing a sigmoidectomy safely?

Doctor’s Tip

One helpful tip a doctor might tell a patient about sigmoidectomy is to follow post-operative care instructions closely to promote healing and prevent complications. This may include taking prescribed medications, maintaining a healthy diet, and avoiding strenuous activities. Additionally, attending follow-up appointments with your healthcare provider is important to monitor your recovery progress.

Suitable For

Patients who are typically recommended sigmoidectomy include those with:

  • Colovesical fistulas, such as in the case of a sigmoidovesical fistula resulting from a sigmoidovesical diverticulum
  • Highly advanced cancer or inflammatory diseases that pose a risk of ureteral injury during surgery
  • Marked surrounding inflammatory changes that increase the risk of ureteral damage
  • Refractory urinary tract infections that may be related to sigmoid abnormalities

In cases where there is a high risk of ureteral damage during surgery, techniques such as the use of a near-infrared ray catheter (NIRC) for visual navigation of the ureter may be employed to ensure the integrity of the ureter is preserved during sigmoidectomy.

Timeline

Before sigmoidectomy:

  • Patient experiences symptoms such as recurrent urinary tract infections and abdominal pain.
  • Diagnostic tests such as imaging studies and endoscopy are performed to confirm the presence of a sigmoidovesical fistula.
  • Treatment options are discussed with the patient, including the need for surgery.
  • A ureteral stent may be placed before surgery to reduce the risk of ureteral injury during the procedure.

After sigmoidectomy:

  • Laparoscopic surgery is performed to remove the affected portion of the sigmoid colon and repair the fistula.
  • Near-infrared ray catheter (NIRC) is used during surgery to visually navigate the pathway of the ureter and preserve its integrity.
  • The sigmoidectomy is completed safely, and the patient is monitored for any complications post-operatively.
  • Patient undergoes a recovery period and may need to follow up with their healthcare provider for further management of their condition.

What to Ask Your Doctor

  1. What is a sigmoidectomy and why is it necessary in my case?
  2. What are the risks and potential complications associated with sigmoidectomy?
  3. How long is the recovery period after sigmoidectomy and what can I expect during the recovery process?
  4. Will I need a ureteral stent or other precautions taken before the surgery to prevent ureteral injury?
  5. Can you explain the use of near-infrared ray catheter (NIRC) during the surgery and how it helps in preserving the integrity of the ureter?
  6. Are there any alternative treatment options to sigmoidectomy that I should consider?
  7. How experienced are you in performing sigmoidectomy surgeries and what is your success rate?
  8. Are there any long-term effects or changes in bowel function that I should be aware of after sigmoidectomy?
  9. How will sigmoidectomy affect my overall health and quality of life in the long term?
  10. Are there any lifestyle changes or dietary modifications I should make before or after the surgery to aid in the recovery process?

Reference

Authors: Okamoto A, Ryu S, Kitagawa T, Marukuchi R, Hara K, Ito R, Nakabayashi Y. Journal: Int J Surg Case Rep. 2022 Jan;90:106641. doi: 10.1016/j.ijscr.2021.106641. Epub 2021 Dec 2. PMID: 34915438