[Fungal aneurysm with ileal conduit fistula to external iliac artery: Complication following laparoscopic radical cystoprostatectomy.].

Objective: Despite the high frequency of complications after a radical cystoprostatectomy, the presence of a fistula that communicates the external iliac artery and the ureteroileostomy has not been described in the medical literature. We present the diagnosis and medical management of a massive hemorrhage through the Bricker´s ostomy due to an external iliac artery´s mycotic aneurysm  fistulized to the ureteroileostomy.

Method: A 78 years old patient under went laparoscopic radical cystoprostatectomy with Bricker-type urinary diversion due to muscle-invasive bladder cancer. During the immediate pos toperative period he presented different complications including sepsis caused by a pelvic collection. Due to a massive hemorrhage through Bricker´s ostomy he went to the emergency department where was diagnosed by CT of active bleeding from right external iliac artery to the interior of the ureteroileostomy. We decided to perform exploratory laparotomy showing an aneurysm with fistulous orifice communicating the medial external iliac artery to Bricker ureteroileostomy. A femoro-femoral bypass, ligation of two centimeters of the external iliac artery, closure of the Bricker´s orifice and right cutaneous ureterostomy was needed.

Results: After the surgery, the patient required renal replacement therapy and vasoactive drugs. Discharge from the hospital was 11 days after the intervention.

Conclusions: The presence of an uncontrolled arterial fistula implies urgent care in a pathology such as the mycotic aneurysm that already constitutes a challenge. Fast diagnosis and surgical skills are essential to increase patient's survival chances.