634 Case Report: Large Perforating Ileal Conduit Stone as A Rare Cause of Abdominal Wall Abscess

Introduction Ileal conduits are common following cystectomy for benign or malignant disease of the bladder. They are associated with late complications such as parastomal hernias, strictures, infections and rarely conduit stone formation. We present a previously unreported case of a significant abdominal wall abscess secondary to a very large perforating conduit stone. Case Report A 59-year-old female with an established ileal conduit due to multiple sclerosis presented acutely with abdominal pain, peristomal mass and fever. A CT showed a large (40mm) calcification with a fluid collection adjacent to the conduit in the subcutaneous tissues. Emergency incision and drainage of the abscess revealed a large abscess cavity containing a stone. Conduitoscopy demonstrated a narrow stoma and a perforation between the abscess cavity and the lumen of the conduit suggesting extrusion of the stone through an eroded area in the wall of the conduit. A Foley catheter was inserted to bypass the perforation. The patient recovered well after the procedure with the addition of antibiotics. Subsequent conduitoscopy showed closure of the perforation with these measures. Conclusions Conduit stones are rare but have the potential to perforate the urinary conduit. We believe that the subcutaneous location of the perforation allowed it to go unnoticed and the stone to achieve a significant size before acting as a nidus for infection. A more proximal perforation would likely result in an intraperitoneal urine leak and earlier presentation with an acute abdomen.