腎或は後腹膜腫瘍と誤られた膵仮性嚢腫の1例

Abstract

A 5-year-old boy was admitted to the Kyoto U n iversity Hospital on August 10, 1954, with the chief complaint of a mass in the left upper quadrant of 2 weeks duration. He was in an automobile accident 3 months before and received a blow to the upper portion of abdomen. He was immediately hospitalized and treated for shock with rapid improvement. Physical examination was negative except for abdominal findings. The abdomen soft, but a large, firm, smooth, rounded mass was proved in the left upper quadrant by bimanual palpation and showed good respiratory mobility. Laboratory findings were negative except for slight leucocytosis. The gastrointestinal series showed the stomach was pushed foreward, and the lateral views revealed a generalized defect of the posterior wall of this organ. Barium enema proved a caudal displacement of the left part of the transverse colon. Excretory urography showed the normal right kidney and demonstrated some depression of the renal pelvis and distortion of the upper calices of the left kidney. Retroperitoneal pneumography by the presacral air insulation was not sufficient to permit differentiation between a renal and extrarenal tumor. Preoperative diagnosis was made as renal or retroperitoneal tumor on the left side. On exploration of the abdome n on August 18, a cystic mass was found between the stomach and transverse colon arising from the tail of the pancreas, and the normal left kidney was adherent with it. About 300cc of winelike, brown fluid was aspirated from the cyst. When the cyst was opened, the wall was smooth; and the opening of the cyst was primarily closed following partial resection of this wall. Microscopically the wall of the cyst was composed of fibrous tissue and had no epithelial lining. The final diagnosis was pseudocyst arising from the tail of the pancreas. The postoperative course was uneventful and the patient was discharged from the hospital on August 28, 1959, and found to be in good health one year later. An intravenous pyelogram was normal. In 1953, Abeshouse collected 25 cases of pancreatic cyst si m ulating renal diseases and added 3 personal cases. The authers have collected one additional case and added one personal case bringing the total to 30 cases. A brief review is made regarding pancreatic cyst simulating diseases of the upper urinary tract.