骨盤内異物による膀胱直腸瘻の1例

Abstract

症例は84歳女性.発熱で受診し, 腎孟腎炎の診断にて点滴及び抗生剤投与を施行した.発熱は一時的に軽快したが, 再発熱を操返した.精査で膀胱結石を認めた.腰麻下にて経尿道的膀胱結石破砕術を施行した.結石確認後, 超音波破砕装置にて結石を破砕したが, その際に結石中に異物を認めたため, 手術は結石を取り除いただけで終了した.結石成分はリン酸マグネシウム・アンモニウム結石であった.骨盤内異物による膀胱直腸瘻と診断し, 持続膀胱洗浄を施行し, 異物除去手術, 膀胱直腸瘻根治術, S状結腸ストーマ作成術を施行した.術後レイウス, 発熱, 低蛋白血症による下腿浮腫などを認めたが保存療法により軽快した

We report a case of vesicorectal fistula caused by a pelvic foreign body. An 84-year-old woman presented with urinary tract infection and bladder stone. During transurethral lithotripsy, a foreign body was observed in the stone. CT and colonoscopy revealed a vesicorectal fistula due to a foreign body. After continuous bladder washout over a period of one month, resection of the foreign body, fistulectomy, and sigmoidostomy were performed. The foreign body was suspected to be a medical mesh from a sling operation. After the surgery, the patient's course was uneventful. This is the second patient with vesicointestinal fistula due to a foreign body in the Japanese literature.