交叉性融合腎を合併した尿管異所開口の1例

Abstract

症例は5歳女児で2ヵ月ほど前, 頻尿と発熱を主訴に来院し, 膿尿を認めたことから尿路感染症の診断で抗生剤投与により解熱したが, 腹部超音波で右腎欠損, 膀胱右後方の嚢胞状構造物を指摘され, 精査目的で入院となった.造影CT・ヘリカルCT所見から交叉性腎変位を伴う尿管異所開口で, 右尿管は中腎管嚢胞を経由して腟に開口しているものと診断して手術を行った.開腹, 検索の結果では右腎は左腎下極に融合しており, 逆L字型の交叉性融合腎と判明した.融合部を切開して右腎および尿管を切除し, 尿管下端と中腎管嚢胞は剥離することで尿道狭窄や尿失禁をきたす可能性を考慮して放置した.術後2年経過の現在, 中腎管嚢胞は画像上判別困難な程度に縮小し, 感染等の合併症も生じていない

A 5-year-old girl with a rare anomaly of a single system ectopic ureter draining into the mesonephric duct cyst and ipsilateral crossed fused kidney is presented. Both ureters were catheterized and three dimensional (3-D) images of the urinary tract were reconstructed with helical computed tomographic (CT) data. A mesonephric duct cyst, the right ureter draining into the cyst and an ectopic orifice were well depicted with these images, especially with inferior projection images. 3-D display of helical CT data with a retrograde contrast study is a promising method of obtaining anatomical detail of an ectopic ureter.