EP671 - Colorectal Cancer Following Childhood Ureterosigmoidostomy

Purpose/Background: Ureterosigmoidostomy, a historical urinary diversion for congenital bladder anomalies such as bladder exstrophy, is associated with long-term complications including chronic kidney disease, recurrent infections, urolithiasis, and increased risk of colorectal malignancy. We present the case of a 63-year-old female with a remote history of ureterosigmoidostomy who developed advanced chronic kidney disease and was diagnosed with sigmoid colon adenocarcinoma.

Methods/Interventions: This is a 63-year-old woman with bladder exstrophy status post ureterosigmoidostomy at age 5, CKD stage IV, chronic bilateral hydronephrosis, and recurrent nephrolithiasis managed with bilateral percutaneous nephrostomy tubes. She underwent screening colonoscopy which revealed a sigmoid colon mass. Biopsy demonstrated intermediate- to high-grade adenocarcinoma with signet ring features, pMMR. Staging CT chest/abdomen/pelvis showed no metastatic disease; CEA was 4.4.

Results/Outcomes: Given her oncologic and urologic history, a multidisciplinary plan was made for combined oncologic resection and urinary diversion. Using a robotic approach, first the ureters were separated from the colon, and an ileal conduit was fashioned using a Wallace anastomosis. Then sigmoid colectomy with high ligation of the inferior mesenteric artery was performed and intracorporeal side-to-side stapled anastomosis. A JP drain was placed for postoperative monitoring of intraperitoneal creatinine levels.

The patient recovered well postoperatively with early return of bowel function, adequate oral intake, and good urostomy output. Bilateral nephrostomy tubes were successfully clamped, and JP drain creatinine remained low, allowing removal prior to discharge. She was discharged home on postoperative day 6 in stable condition. Final pathology demonstrated poorly differentiated adenocarcinoma, T2N0, proficient mismatch repair status.

Conclusion/Discussion: Ureterosigmoidostomy, once a common urinary diversion for bladder exstrophy, carries significant long-term risks, particularly the development of colorectal carcinoma at the ureterocolonic anastomosis. The latency period may extend decades, making lifelong surveillance essential. In this case, the patient presented more than 50 years after her initial diversion with advanced CKD, recurrent nephrolithiasis, and a newly diagnosed sigmoid adenocarcinoma. Management required careful multidisciplinary planning to balance oncologic resection with urinary diversion and renal preservation. This case highlights the importance of vigilance for malignancy in patients with a history of ureterosigmoidostomy, the role of colonoscopic surveillance, and the value of collaborative surgical planning in managing patients with complex urologic and oncologic needs.

Flexible sigmoidoscopy demonstrating sigmoid colon mass