A CASE OF ADVANCED RECTAL CANCER REHABILITATED BY CONSTRUCTION OF A BLADDER SUBSTITUTE

A patient with advanced rectal cancer which necessitated total removal of intrapelvic organs was able to be followed up for 2 years 7 months after the reconstruction with Sheele's bladder substitute. For this the patient's strong will for recovering social activities was satisfied. The patients was a 52-year-old man. There was a history of pulmonary resection of the right upper lobe and thoracoplasty for pulmonary tuberculosis. The patient underwent transurethral prostatectomy in 1988, when an ulcer was noted in the posterior wall of the bladder. The ulcer was not cured. In, April 1989, a Borrmann II tumor was detected by colonoscopy in the rectum 10 cm oral to the anus, and a diagnosis of ademocarcinoma was made by biopsy. Pelivic CT scan revealed invasion to the posterior wall of the bladder, the right ureter and the ileocecum, and the lesion was considered as advanced rectal cancer on May 9, 1989. Low anterior resection of the rectum, resection of the posterior wall of the bladder, ileocecal resection, and partial resection of the right ureter were carried out. Intestinal continuity was made by rectosigmoidostomy, ileo-ascending colon anastomosis. Reconstruction of the urinary bladder was made using substitute. Which was made by prepaing a 30 cm ileal loop into which the bilateral ureters were grafted. And this ileal loop was anastomosed to the auterior wall of the bladder. This bladder substitute had a capacity of 600 ml and tolerated a maximum internal pressure of 50 mmHg. Evacnation of urine was performed by adding abdominal pressure at the time of louer abdominal distension feeling. No urinary in captiuence bas been noted residual urine.