Rectal Wall Recurrence Of Transitional Cell Carcinoma Of The Bladder Masquerading As An Abscess Cavity

摘要

Presented is a case report of a man who developed recurrent transitional cell carcinoma, post radical cystoprostatectomy with negative lymph nodes that presented as a peritoneal abscess/ hematoma. This patient presented as a diagnostic dilemma in that his recurrent transitional cell carcinoma did not present in a typical manner. He was febrile and his CT scan revealed a pelvic mass filled with fluid and air. Additionally, all lymph nodes were negative at the time of the cystectomy, which further decreased his likelihood of having residual disease. Introduction Radical cystectomy is the standard of care for muscle-invasive transitional cell carcinoma of the urinary bladder. However, this procedure is fairly invasive and is not without frequent complications, occurring in about 25% of cases., The most common early complications are hematoma and abscess formation. Hematomas usually produce no symptoms and are discovered incidentally on a CT scan.3 Abscess formation can also be indolent but usually produces systemic signs of infection and appear on CT scan as pelvic masses with air bubbles. In fact, on CT a pelvic mass containing gas is diagnostic of an abscess formation. Conversely, peritoneal bladder cancer recurrence is seen on CT scan as a solid mass, with or without central necrosis, that does not contain air pockets.4 Case Report A 69-year-old man, who had undergone a radical cystoprostatectomy with ileal conduit for muscle invasive bladder transitional cell carcinoma 5 months previously, presented to the clinic with the inability to have a bowel movement. A CT scan demonstrated an 8.4 x 6.6 cm pelvic fluid collection. An interventional radiologist placed a percutaneous drain, and while in the hospital, the patient began moving his bowels again. The patient was hemodynamically and vitally stable and was discharged with the drain still in place.At the time of his cystoprostatectomy, bilateral inguinal node dissections were performed, and all lymph nodes as well as bilateral ureteral margins, were determined to be negative for malignancy under pathologic review. Additionally, the prostate was noted to have prostatic adenocarcinoma with uninvolved margins. A CT scan two weeks following the surgery demonstrated normal post-surgical changes with no evidence of abscess, hematoma, or soft tissue masses.The man presented to the ED two weeks after the drain placement complaining of bleeding around the drain catheter. A CT scan was repeated, and demonstrated an increase in size of the pelvic fluid collection (figures 1 and 2).