El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Typhoid Fever. Intestinal hemorrhage due to a typhoid fever. The ileocecal valve and the terminal ileum are seen in the video clip. There are several tiny and bleeding ulcers. Invasion of Peyer patches occurs during either the primary intestinal infection or secondary bacteremia, and further seeding occurs through infected bile. The Peyer patches become hyperplastic with infiltration of chronically inflamed cells, which may lead to necrosis of the superficial layer and ulcer formation, with potential hemorrhage from blood vessel erosion or peritonitis from transmural perforation.

Typhoid Fever.

 Intestinal hemorrhage due to a typhoid fever.
 The ileocecal valve and the terminal ileum are seen
 in the video clip. There are several tiny and bleeding
 ulcers.  
 Invasion of Peyer patches occurs during either the primary
 intestinal infection or secondary bacteremia, and further
 seeding occurs through infected bile. The Peyer patches
 become hyperplastic with infiltration of chronically
 inflamed cells, which may lead to necrosis of the superficial
 layer and ulcer formation, with potential hemorrhage from
 blood vessel erosion or peritonitis from transmural
 perforation.   

Ileal Neobladder Substitution (ileal bladder) Radical cystectomy remains one of the most effective methods of control of invasive bladder cancer. The construction of an ileal conduit remains a tried and tested method of urinary diversion.

Video Endoscopic Sequence 1 of 9.

Ileal Neobladder Substitution (ileal bladder)

 Radical cystectomy remains one of the most effective
 methods of control of invasive bladder cancer. The
 construction of an ileal conduit remains a tried and tested
 method of urinary diversion.

 Removal of the bladder (cystectomy) necessitates
 reconstruction of the lower urinary tract. Bladder cancer is
 the most common reason for cystectomy. However, the
 same principles apply to patients who undergo pelvic
 exenteration for other malignancies, or who require
 cystectomy for non-malignant conditions such as birth
 defects, trauma, or neurologic disorders.
This image shows one of the uretero-enteric anastomosis.

Video Endoscopic Sequence 2 of 9.

This image shows one of the uretero-enteric anastomosis.

 Ureterosigmoidostomy was the first widely used surgical
 technique for urinary diversion, providing an effective
 diversion that relied upon the anal sphincter for continence.
 However, deterioration of renal function over time,
 metabolic complications, and the increased risk for the
 development of secondary malignancies limited its
 usefulness. Subsequent surgical advances in reconstructive
 techniques have led to major improvements in both
 functional outcomes and quality of life.
A close up of the uretero-enteric anastomosis. Ureterosigmoidostomy was the first widely used surgical approach for urinary diversion after cystectomy. The ureters were implanted into the sigmoid colon and the anal sphincters were relied upon to provide continence. Approximately 50 years of experience with this approach defined a series of complications that guided subsequent surgical progress:

Video Endoscopic Sequence 3 of 9.

A close up of the uretero-enteric anastomosis.

 Ureterosigmoidostomy was the first widely used surgical
 approach for urinary diversion after cystectomy. The
 ureters were implanted into the sigmoid colon and the anal
 sphincters were relied upon to provide continence.
 Approximately 50 years of experience with this approach
 defined a series of complications that guided subsequent
 surgical progress:

  • Gradual deterioration of renal function, secondary both to chronic urinary tract infection, which was a result of mixing of the urinary and fecal streams, and to obstruction of the ureterointestinal anastomosis
  • Hyperchloremic acidosis, as a result of resorption of excreted urinary products by the bowel mucosa
  • Development of secondary cancers in the sigmoid colon near the site of ureteral implantation.
The most commonly used bowel segments for continent urinary diversion are either ileum or a combination of terminal ileum and ascending colon. Ensuring that all continent diversions store and empty urine at low pressures is paramount. High storage and voiding pressures ultimately cause high-pressure reflux nephropathy and may result in renal failure; therefore, all bowel segments used for continent diversion, with the exception of their use in a ureterosigmoidostomy procedure, initially are detubularized. The bowel segments then are refashioned in a more spherical shape, which increases capacity and decreases luminal pressure by a magnitude of 3- to 4-times lower than the original segmental pressure.

Video Endoscopic Sequence 4 of 9.

 The most commonly used bowel segments for continent
 urinary diversion are either ileum or a combination of
 terminal ileum and ascending colon. Ensuring that all
 continent diversions store and empty urine at low pressures
 is paramount. High storage and voiding pressures
 ultimately cause high-pressure reflux nephropathy and may
 result in renal failure; therefore, all bowel segments used
 for continent diversion, with the exception of their use in a
 ureterosigmoidostomy procedure, initially are
 detubularized. The bowel segments then are refashioned in
 a more spherical shape, which increases capacity and
 decreases luminal pressure by a magnitude of 3- to 4-times
 lower than the original segmental pressure.
This image displays the two uretero-enteric anastomosis. Orthotopic diversion (ortho meaning correct, topic meaning of a place) is a term that describes the reconstructed pouch anastomosed to the native urethra. Neobladder is a term used synonymously with orthotopic diversion. The continence mechanism in an orthotopic diversion is the native urethral rhabdosphincter. Continent diversion may be further categorized into 3 types, (1) orthotopic or neobladder diversion, (2) continent catheterizable diversion, and (3) ureterosigmoidostomy.

Video Endoscopic Sequence 5 of 9.

This image displays the two uretero-enteric anastomosis

 Orthotopic diversion (ortho meaning correct, topic meaning
 of a place) is a term that describes the reconstructed pouch
 anastomosed to the native urethra. Neobladder is a term
 used synonymously with orthotopic diversion. The
 continence mechanism in an orthotopic diversion is the
 native urethral rhabdosphincter. Continent diversion may
 be further categorized into 3 types, (1) orthotopic or
 neobladder diversion, (2) continent catheterizable diversion,
 and (3) ureterosigmoidostomy.
Ileal Bladder5

Video Endoscopic Sequence 6 of 9.
Ileal Bladder6

Video Endoscopic Sequence 7 of 9.

Again the two uretero-enteric anastomosis

 
Ileal Bladder8

Video Endoscopic Sequence 8 of 9.

Urostomy pouch

 
Ileal Bladder9

Video Endoscopic Sequence 9 of 9.

Urostomy pouch

 After having Radical Cystectomy, where the bladder is
 removed, it is necessary to have a mean of collecting the
 urine from the stoma that was created; the urine containing
 body waste must be brought to the out side, the stoma, and
 disposed of. If we did not ware a Urostomy pouch.