BackgroundIleocolic resection and creation of an ileal conduit can be associated with unexpected compromise of intestinal blood supply that can lead to major anastomotic complications. These problems can be anticipated and avoided.MethodsNine patients were identified who underwent a right colectomy with an ileal conduit urinary diversion between 1987 and 1994. The records were retrospectively reviewed for information on operative procedures, outcomes, and complications. Precautions taken in the performance of the operative procedures that related to the ileal conduit and colectomy were recorded.ResultsFive of the nine patients reported intestinal anastomotic complications isolated to the ileocolic area. These included two fistulae, one anastomotic leak with an abscess, one ischemic necrosis of the right colon, and one anastomotic stricture. Patients with an uncomplicated course had undergone resection of a previous ileal-ileal small bowel anastomosis done after ileal conduit creation, or had an extended small bowel resection to secure well-vascularized bowel for anastomosis. There were no complications related to preservation of the ileal conduit blood supply, its integrity, or its function.ConclusionsIleocolic resection with ileal conduit formation can result in a poorly vascularized anastomosis. This poor vascularity is caused by resection of the ileocolic artery during right colectomy and isolation of the superior mesenteric artery to supply the urinary conduit; any remaining ileum may be poorly vascularized. Re-resection of any previously done ileal anastomosis and extension of the proximal and distal resections to obtain well-vascularized bowel will prevent anastomotic complications.