A Case of Hyperchloremic Metabolic Acidosis due to Ileal Conduit after Total Pelvic Exenteration

Abstract

A 78-year-old woman who presented with frequent urination and residual urine was diagnosed with primary advanced sigmoid colon cancer which had invaded the bladder, right ureter, and ileum end. After neoadjuvant chemotherapy, the tumor response to the therapy was classified as stable disease. There were no unresectable factors. Thus, we performed total pelvic exenteration to remove the ileocecal region, left-sided colon, bladder, bilateral ureters, uterus and ovary, and ileal conduit formation. The postoperative course was uneventful, but she started to have loss of appetite after discharge. An arterial blood gas sample demonstrated hyperchloremic metabolic acidosis (pH 7.12) with a normal anion gap caused by chloride reabsorption via the ileal conduit. Symptomatic remission was gained with intravenous administration of sodium bicarbonate. The patient is now on alkalinizing therapy with oral sodium bicarbonate without any symptoms such as appetite loss. Metabolic acidosis due to ileal conduit is rare, however, colorectal surgeons should recognize the complications after urinary diversion.