Géantes lithiases de stase sur vessie iléo-caecale

Bladder exstrophy is a malformation characterized by subumbilical anterior abdominal wall and anterior bladder wall deishence. It affects nearly 30.000-40.000 births per year, with a higher prevalence in boys. External continent urinary diversion creates a long-term outcome. However, it is not devoid of complications. We report the case of a 30-year old female patient who had undergone cystectomy with bladder replaced with ileo-caecal segment for bladder exstrophy 13 years earlier. She was followed up for 5 years and then lost to follow up. In March 2017 she presented with painful abdominal heaviness as well as constipation evolving in a context of apyrexy and good general condition. Clinical examination showed good general health, midline laparotomy scar, continent uninvaginated urinary pouch valve. Pelvic examination was unremarkable. Hypogastric palpation showed nonpainful stony-hard mass. Urinary tract without preparation showed calcic opacity 130*110 mm as well as symphysis disjunction. Renal and pelvic ultrasound showed several hyperechogen images with posterior shadow cone occupying the pelvis, two well differentiated kidneys of normal size without ureteric hydronephrosis. CT urography showed 5 big calcium stones with an average density of 730 UH, the most voluminous of which measured 112*101 mm, in the neobladder. Renal function was normal and cytobacteriological examination of urine showed ESBL-producing E coli urinary tract infection sensitive to carbapenems. Treatment was based on suitable antibiotic therapy associated with entero-cystolithotomy involving laborious extraction of 5 big stones. Spectrophotometric examination revealed phospho-ammonium-magnesium stones. The postoperative course was uneventful, post operative urinary tract without preparation showed no stones.