外傷にて腎盂破裂をきたした先天性水腎症の1例

Abstract

19歳男.ボクシング練習中に上腹部正中に軽いパンチを受け, その夜左側腹部の激痛により左腎外傷の疑いで入院となった.腹部理学所見でブルンベルグ兆候を認めた.又, 検査で白血球上昇と腎機能障害を認めた.CTで後腹膜腔に大量の液体貯留を認めた.腹腔内には液体の貯留は無く, 他臓器に損傷も無かった.外傷による左水腎症破裂を考え, 8Frピッグテイルカテーテルを挿入した.穿刺液は尿と確認された.翌日のCTでもまだ液体の大量貯留が確認され, 7Feピッグテイルカテーテルを挿入した.3日目に尿量は正常となったが, ドレナージが不十分で, 腹部鈍痛, 嘔気, 嘔吐など消化器症状があり発熱も継続した為左腎摘出術を施行した.腹膜及び筋膜との癒着は軽度で膿瘍形成もなく, Gerota筋膜ごと腎を摘出した.病理で腎盂尿管移行部狭窄による先天性水腎症と診断された.術後, 消化器症状は改善し10日目に退院した

A 19-year-old male patient was admitted with the chief complaint of left abdominal pain. After receiving a mild punch in the abdomen during boxing exercises, he had severe abdominal pain and was brought to an emergency room. Since abdominal CT scanning revealed the retention of massive fluid in the retroperitoneum, hydronephrotic rupture due to the trauma was diagnosed and nephrectomy was performed. The removed kidney was filled as a result of urinary retention, and congenital hydronephrosis accompanied by the ureteropelvic junction obstruction was macroscopically and pathohistologically diagnosed. Postoperative course was favorable and the patient was discharged on the 10th hospital day.