Gross hematuria from an ileal conduit as a first presentation of portal hypertension.

Background: A 76-year-old man who underwent cystoprostatectomy with ileal conduit urinary diversion for muscle-invasive bladder cancer presented to his urologist 4 years later with episodes of spontaneous gross hematuria filling his ostomy bag with fresh clots.

Investigations: Physical examination, urine culture, urine cytology, peripheral smear, complete blood count, loopogram, CT-intravenous pyelogram, loop endoscopy, bilateral ureteroscopy, liver function tests, CT angiography, (99m)Tc-tagged red cell scan, hepatitis panel, measurement of transjugular wedge pressure, transjugular liver biopsy with pathologic analysis and re-evaluation of CT angiogram.

Diagnosis: Hematuria secondary to portal hypertension.