Can you identify the site of fistulization: proximal ileum or jejunum?
Our patient underwent a fistulectomy within the following weeks. During surgery, cement-like adhesions were found throughout the abdominal cavity and around the posterior wall of the bladder dome. These retroperitoneal adhesions were probably responsible for the mild urinary tract obstruction seen in this patient. Because of the distorted anatomy, it was not possible to identify the exact site of fistulization, although the surgeons felt that the enteric opening was in the middle part of the small intestine. Based on the preoperative evaluation, and because the phenotype of electrolyte complications did not fit that of either type of urinary diversion described earlier, it is possible that our patient had a mixed jejunal and ileal conduit-like syndrome. Such a syndrome may have occurred from fistulization of the bladder into the jejunum, forcing urine to come into contact with the mucosæ of both jejunum and ileum. Presumably, the very large surface of mucosa to which the patient’s urin
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