虫垂膿瘍による水腎症の1例

Abstract

76歳女.発熱, 全身倦怠感を自覚し, 排泄性腎盂造影(IVP)で右水腎症を認めた.右下腹部に弾性硬の腫瘤を触知したが, 筋性防御は認めなかった.逆行性右腎盂造影(RP)で, 肘部尿管に全周性狭窄と水腎症を認めた.また, CTでは狭窄部位に一致して, 右尿管前面に腫瘤を, MRIでもT1強調画像で低密度, T2強調画像で等密度の腫瘤を認め, 右水腎症の原因は骨盤内腫瘤によると思われた.下腹部正中切開による試験開腹で, 回盲部は後腹膜腔と強固に癒着し, 内側に授動すると, 虫垂の末梢端が, 尿管前面で穿孔し, 膿瘍を形成していた.回盲部切除, 尿管部分切除, 右尿管再建術を施行した.単腎症例に発症した虫垂膿瘍による水腎症で, 病理組織所見で悪性所見は認めなかった

An appendiceal abscess was complicated with right hydronephrosis in a 76-year-old woman who complained of general fatigue and fever. Ultrasonography demonstrated right hydronephrosis, and retrograde pyelography confirmed the hydronephrosis and showed ureteral stenosis. Computed tomography scan revealed a low-density area measuring 38 x 35 mm in size, anterior to the right ureter. Ureteroscopy and the biopsy of the mucosa was carried out, but malignant cells were not found. An exploratory laparotomy was performed. The mass had developed from the cecum and involved the ureter, requiring ileocecal excision, left partial ureterectomy and ureteric substitution with a Boari's flap. The histological diagnosis was an appendiceal abscess. The postoperative course was uneventful.