突然の腹部膨満を主訴に発症した腎嚢胞自然破裂の1例

Abstract

21歳女.突然の腹部膨満を主訴に発症し, 感染性腎嚢胞の尿路への自然破裂の症例であった.本人の訴えからは急激な嚢胞性病変増大と思われたが, 実際に1日で20×11×10cmの大きさに達したとは考えにくく, 巨大な腎嚢胞に感染を起こし内圧が急激に上昇し, 腹部の膨満を自覚するに至ったと推察された.その後のサイズの縮小と膿尿は, 腎嚢胞の尿路への破裂を示唆するが, 穿刺当日は嚢胞造影で尿路は造影されず, 尿路との交通は一時的に閉鎖していた.カテーテルを留置し数日で排液量の増加とクレアチニン値の上昇を認めたのは, 尿路より高かった嚢胞内圧が逆転し低下したため, 尿路から嚢胞への交通が再開したものと考えられた

A 21-year-old woman was referred to our hospital for sudden onset of right flank distension. Ultrasonography, abdominal CT scan and MRI revealed a giant cyst 20 x 11 x 10 cm on the right kidney. Percutaneous puncture of the lesion was performed and fluid was drained. The fluid was yellowish and puriform. Gradually, the drainage fluid creatinine concentration increased. Cystography revealed communication between the lesion and the pyelocalyceal system. The patient underwent drainage for 25 days, causing the cyst to almost fully collapse. No recurrence has been detected in the follow-up for about 1 year. This case is the 38th case of the rupture of a renal cyst reported in the Japanese literature. We reviewed 37 cases of rupture of renal cysts previously reported in Japan.