despite recent advancement in radiotherapy and molecular - related therapies , radical cystectomy remains the mainstay of treatment for muscle - invasive bladder cancer . although technically easier to perform compared with continent reservoirs , ileal conduit has not been associated with lower complications . we report a case of a male patient with a recent 4-month history of cystectomy and ileal conduit , presented to the accident and emergency department with an ileal conduit stricture . an 80-year - old gentleman presented to a&e department for general weakness and paralysis of all four limbs . his past medical history includes type 2 diabetes mellitus , spinal stenosis at the level of l2/l3 , l3/l4 and l5/s1 . he said that he had become unwell since his cystectomy operation 4 months prior to his attendance at a&e . he also denied any loin pain . on examination , his abdomen was soft , a draining ileal conduit stoma was observed , sensation and reflex at all limbs were intact , but motor power of all limbs was diminished . his initial blood test shows the potassium level of 9.1 meq / l , serum urea of 20.1 mm / l , creatinine of 521 m / l . he was immediately treated with calcium gluconate 10% , insulin - sliding scale and salbutamol nebulisers . an ultrasound scan of the renal tracts was carried out and subsequently shows bilateral hydronephrosis . computed topography of the head revealed no intracranial bleed or infarct for the cause of paralysis . due to his worsened renal function , a loopogram was performed and showed a stricture 4 cm proximal to the skin opening of the ileal conduit ( see fig .  1 ) . figure  1:loopogram revealed the stricture at 4 cm proximal to the skin opening of the conduit . loopogram revealed the stricture at 4 cm proximal to the skin opening of the conduit . the patient was treated conservatively with 2 weeks of intravenous ciprofloxacin antibiotics and nephrostomy tubes were inserted as a diversion . the surgical exploration revealed a small fibrous tissue band of mesenteric origin 4 cm proximal to the skin opening of the ileal conduit . the patient recovered uneventfully , his renal function improved remarkably and he was discharged back to community care after a stormy hospital stay . ileal conduit stricture has been described in a 2.58.5% at a median of 10 years after surgery . in relation to our case prior authors have suggested the occurrence of ileal conduit stricture is secondary to ischaemia which has resulted in severe transmural inflammation with submucosal fibrosis . magnusson et al .   used transmission electron microscopy to demonstrate a reduced height of microvilli , presence of glycocalyceal bodies and an increased number of lysosomes . other hypotheses such as reaction to noxious agent in the urine , immune causation were also proposed . ileal conduit strictures can be investigated through three means : computed topography urogram , loopogram and looposcopy . due to our patient 's nature of renal failure , a series of x - ray was initiated after contrast liquid was injected through the stoma . in our case , it showed a stricture 4 cm proximally to the skin opening of the ileal conduit . stenosis at the skin level can be managed by dilating the stoma opening , usually by inserting a lubricated digit down to the fascial layer for several minutes . the downside is patients may need frequent and repeated technique , and it also carries the small risk of forming false passage or opening . in our case , although ileal conduit stricture is rare , this potentially serious and life - threatening complication can be prevented with cautious surgical closure of abdomen . stringent follow - up in stoma centre is also an essence to continuity of patient care . in the case described , the patient experienced significant morbidity in terms of re - admission to hospital , further surgical procedures and prolonged hospital stay . consequently , surgeons should always be mindful of checking that the mesenteric pedicle is not twisted to avoid further perils during the postoperative period .
ileal conduit remains a widely used urinary diversion performed after radical cystectomy . 
 however , complications of ileal conduits remain an important concern in urological surgery . we report a rare case of an ileal conduit stricture , which can have grim complications if unobserved during the operation . following an initial operation of radical cystectomy and ileal conduit formation in france in 2011 , an 80-year - old male travelled back to the uk after 4 months of general weakness and limb paralysis . 
 initial blood test shows life - threatening hyperkalemia and worsened renal function . 
 subsequent ultrasound kub scan and loopogram revealed obstructive uropathy . 
 the initial management includes intravenous antibiotics and bilateral nephrostomies were inserted to aid diversion of urine . 
 a thorough surgical exploration revealed a twisted , fibrous mesenteric band adhered to the proximal part of the ileal conduit . only one case report of ileal conduit stenosis was described many years after the procedure .