盲腸癌を原因とした盲腸膀胱瘻および直腸膀胱瘻の1例

Abstract

84歳男.発熱及び混濁尿を認め受診した.抗生物質の投与で症状の改善が認められないため, 精査加療目的で入院となった.膀胱造影などから直腸癌又はS状結腸癌の浸潤による膀胱腸瘻の術前診断により, 全身麻酔下に手術を施行した.術後19ヵ月の現在, 盲腸腫瘍の再発を認めず経過観察中である.病理組織学的所見は粘液を産生する円柱状の腺癌細胞の増生像で, 膀胱筋層内にも同癌細胞の浸潤像があった

A hundred and nine cases of cecovesical fistula are described in the literature. Although its origin is usually reported to be appendicitis, we present a rare case of cecovesical and rectovesical fistulas secondary to mucinous adenocarcinoma of the cecum. An 84-year-old man was referred to our hospital with the chief complaints of fever and cloudy urine. An enterovesical fistula was seen on cystography, and cystoscopy showed a lot of mucinous fluid in the bladder and the papillary tumor arising from the enteric mucosa was identified through the fistula. Transurethral biopsy of the tumor revealed a mucinous adenocarcinoma of suspected colonic origin. At the operation, cecovesical and rectovesical fistulas secondary to cecal tumor were removed by right hemicolectomy, low anterior resection of the rectum and partial cystectomy.