気腫性膀胱炎を合併した気腫性腎孟腎炎の1例

Abstract

74歳女の本症例ではCTにて気腫性変化が腎盂腎杯に限局していたこと, 患側に軽度水腎症が認められたこと, 膀胱鏡所見にて右尿管口を栓するような所見を認めたこと, 抗生剤に対する反応が良好であったこと, 血糖コントロールが比較的良好であったこと, などからSingle Jカテーテル挿入によるドレナージのみで, 腎摘出術は施行せずに治癒しえた.気腫性膀胱炎に対しては, 膀胱バルーンカテーテル留置にて神経因性膀胱による排尿障害を改善させ治癒せしめた.又, 腎静態シンチグラムにて左右腎機能に差は認められなかったことより, 気腫性変化は腎杯の粘膜に留まっており, 腎機能障害が生じなかったと思われる

A 74-year-old woman with diabetes mellitus had a high fever, and was treated with antibiotics and insulin in another hospital. She was referred to our department, because CT scan showed the right hydronephrosis and the abnormal gas shadow in the right renal calyces. Ureteral catheterization was performed on the right side and cloudy urine was drained. Urine culture yielded E. coli. Since submucosal emphysematous changes were demonstrated in the bladder mucosa by cystoscopy, she was diagnosed with emphysematous pyelonephritis with emphysematous cystitis associated with diabetes mellitus. Administration of antibiotics and insulin and the ureteral catheter drainage improved her condition immediately. Abnormal gas shadow on CT scan and submucosal emphysema on cystoscopy disappeared. We reviewed 110 cases of emphysematous pyelonephritis and 23 cases of emphysematous cystitis including our case in Japan, and report their clinical characteristics.