S状結腸憩室炎による膀胱炎症性偽腫瘍の1例

Abstract

65歳女.切迫性尿失禁を主訴とした.腹部超音波検査所見にて, 膀胱内の径50mmの腫瘍を認め, 膀胱鏡にて膀胱三角部の表面平滑な非乳頭状広基性腫瘤を認めた.また, オリーブ油CTにて膀胱左壁に腫瘍を認めた.TUR生検を行い, 病理学的に移行上皮下に好酸球, 形質細胞, 毛細血管の増生と拡張を認めた.その後, 膀胱刺激症状が悪化したため, 骨盤部CTを行ったところ, 膀胱とS状結腸の内部の骨盤内膿瘍, 多数の結腸憩室を認めた.以上より, S状結腸憩室炎の穿孔による骨盤内膿瘍を疑った.注腸造影にてS状結腸に造影剤の漏出を認めたが, 抗生剤投与により炎症反応が低下し, 本人が手術を希望しなかった.その後, 発熱と膀胱腫瘍の拡大を認め, 抗生剤が無効であったため, S状結腸切除術を行った.術後経過は良好で, 術後約2週間で退院し, 術後4ヵ月現在, 再発は認めない

A 65-year-old female presented to our hospital with a 6-month history of pollakuria, low-grade fever and urgent incontinence. Cystoscopy revealed a nonpapillary bladder tumor that was 50 mm in diameter in the trigon. Computed tomography showed the abscess between the urinary bladder and sigmoid colon. Transurethral resection was performed and the histology consisted of inflammatory lesions with inflammatory cell infiltration, which was diagnosed as an inflammatory pseudotumor due to diverticulitis of the sigmoid colon. Sigmoidectomy was subsequently performed. A fistula between the urinary bladder and the sigmoid colon was not detected. Cystoscopy 2 months after the operation revealed no signs of a bladder tumor.