Sigmoid Adenocarcinoma Occurring 72 Years After Ureterosigmoidostomy: Implications for Lifelong Surveillance

Ureterosigmoidostomy, once commonly performed for bladder exstrophy, was abandoned due to increased risk of adenocarcinoma of the rectosigmoid. Many patients who had ureterosigmoidostomy at birth underwent subsequent conversion to ileal loop urinary diversion. We present a case of sigmoid adenocarcinoma at the site of ureterosigmoidostomy 72 years after construction, and 51 years after conversion to ileal conduit. A 72-year-old woman who underwent an ureterosigmoidostomy as a neonate, and a subsequent takedown and ileal urinary conduit creation, presented with a partially obstructing sigmoid mass. Surgical exploration revealed the tumor was adjacent to the previous ureterocolic anastomosis site. An anterior resection of the rectosigmoid was performed. Histology revealed T3N0 adenocarcinoma adjacent to the prior ureterosigmoidostomy. Patients with a history of ureterosigmoidostomy are at lifelong increased risk of rectosigmoid adenocarcinoma; cancer can occur decades after diversion, even following conversion to ileal urinary conduit.