水腎症を合併し診断が困難であった虫垂膿瘍の1例

Abstract

症例は67歳女性で, 1ヵ月ほど前から右腹部痛出現の為来院し, 単純X線像では右腎内に小結石を認めるのみで, 排泄性腎盂造影(IVP)では右水腎症を認めた.精査目的で入院待機中に右側腹部の疝痛発作のため他院泌尿器科に緊急入院し, IVPで上部尿路溢流を合併する右水腎症, 腹部CTで右腎背側の尿貯留腫と骨盤内腫瘤を認めた.前医でのCT検査で右骨盤内尿管腹側に腫瘤を認め, 右尿管はこれより近位で水尿管を呈し, 骨盤内腫瘤と水尿管の接する部位に嵌頓していない尿管結石が認められ, 右腎背側には尿貯留腫を認めた.以上より, 右水腎症は骨盤内腫瘤による圧迫によるもので, 今回そこに結石が下降したため上部尿路外溢流と疝痛発作が起こったものと考えられた.骨盤内腫瘤のCTガイド下針生検結果は慢性炎症細胞の浸潤のみで, 尿貯留腫を伴う骨盤内腫瘍の診断で腫瘍摘出術を施行した.摘出標本の病理組織学的所見から虫垂膿瘍と診断された

We report a case of appendiceal abscess complicated with right hydronephrosis in a 67-year-old woman. She visited our department complaining of right flank pain. Intravenous pyelography (IVP) showed hydronephrosis and hydroureter on right and a narrow ureter at the pelvic brim. A pelvic computed tomographic scan revealed a low density area measuring 44 x 37 mm in size, anterior to the right ureter, which was thought to be a pelvic tumor. Further examination did not reveal the origin of the tumor. An exploratory laparotomy was performed. The tumor developed from the cecum and adhered to the right ureter. The appendix was not found. The tumor was resected with the cecum while the ureter was preserved. Histological investigations revealed an appendiceal abscess. The postoperative course was uneventful. IVP after the operation showed the hydronephrosis to have resolved.