British Journal of Urology (1998), 82, 916

CASE RE PORT

Survival of a clam cystoplasty segment after pedicletransectionN. MAHMOOD*, D.F.M. THOMAS and I. EARDLEY*Airedale General Hospital, Keighley and St James’s University Hospital, Leeds, UK

Case report Comment

Clam cystoplasty was first described by Bramble [1] inA 22-year-old man with a neuropathic bladder due tospina bifida was electively admitted for a MitrofanoC 1982 but the largest published experience comes from

the series reported by Mundy and Stephenson, and Fennprocedure. He had previously undergone clam ileocysto-plasty when he was 15 years old. While on holiday et al. [2,3]. In the present case, the cystoplasty developed

its own blood supply such that transection of its pedicleelsewhere 15 months after the ileocystoplasty he hadbeen hospitalized with intestinal obstruction. Emergency at 15 months did not threaten its viability. To our

knowledge, such a case has not previously beenlaparotomy revealed a gangrenous small bowel causedby obstruction from adhesions. During the operation, described.100 cm of non-viable small bowel was resected. He madean uneventful recovery from this operation and was

Referencesdischarged back to the hospital responsible for his pri-

1 Bramble FJ. The treatment of adult enuresis and incontinencemary care. Clam cystoplasty had provided the patientby enterocystoplasty. Br J Urol 1982; 54: 693–6

with a good capacity bladder but this alone did not make2 Mundy AR, Stephenson TP. ‘Clam’ ileocystoplasty for the

him continent. He was finding external condom drainage treatment of refractory urge incontinence. Br J Urol 1985;unacceptable. All treatment options were discussed with 57: 641–6the patient after which a decision was made to proceed 3 Fenn N, Conn IG, German KA, Stephenson TP. Complicationswith a MitrofanoC procedure using the appendix. During of clam enterocystoplasty with particular reference to urinary

infection. Br J Urol 1992; 69: 366–8the laparotomy for the MitrofanoC procedure the mesen-tery of the cystoplasty segment was found to be missing.We believe that the vascular pedicle of the cystoplasty

Authorshad been transected during the emergency surgery for

N. Mahmood, FRCS, Specialist (visiting) Registrar in Urology.the small bowel obstruction, and that the cystoplastyD.F.M. Thomas, MRCP, FRCS, Consultant Paediatric Urologist.

segment had survived by establishing blood supply fromI. Eardley, MA, MChir, FRCS(Urol), FEBU, Consultant Urologist.

the bladder within 15 months. Correspondence: Mr I. Eardley, Consultant Urologist, St James’sUniversity Hospital, Beckett Street, Leeds LS9 7TF, UK.

916 © 1998 British Journal of Urology