腟内異物による膀胱腟瘻の1例

Abstract

14歳.学校の健診で膿尿を指摘され受診した.1日15～20回程度の頻尿および1日に2～3個のパッド使用を要する尿失禁を自覚していた.排尿性尿路造影で骨盤内に6cm程度の円筒形と考えられる異物を認めた.問診では1年前にスプレー缶を自分で腟に挿入し, 抜去しようとしたところキャップが腟内に残ったまま抜けてしまい, そのまま放置していたとのことであった.膀胱造影で膀胱後方への造影剤溢流を認め, 膀胱腟瘻が示唆された.用手的に異物の除去を試みたが不可能であったため, 全身麻酔下に腟内異物除去および経腟的膀胱腟瘻閉鎖術を施行した.腟内を膀胱鏡で観察すると腟口から約2cmのところに異物が認められ, 非観血的に摘出できた.膀胱腟瘻は閉鎖術後3ヵ月で再発したため経腹的閉鎖術を施行し, 以後再発はない

A 14-year-old girl was referred to our hospital with severe pyuria pointed out in a school health check up. An intravenous pyelography and a cystography revealed a foreign body in the pelvic region outside the bladder and pooling of contrast medium in the vagina. Conputed tomography confirmed the foreign body in the vagina. About 1 year earlier, she inserted a hair spray can into the vagina but could not remove its cap. Under the diagnosis of vesicovaginal fistula due to vaginal foreign body, the cap was removed manually and transvaginal repair of the vesicovaginal fistula was performed under general anesthtesia, but it recurred twice. Finally, she underwent successful abdominovaginal repair of fistula. Although a variety of self-introduced objects in the vagina illegally used as a means of sexual gratification have been described, a vesicovaginal complication is very rare.