糖尿病に合併した気腫性腎周囲膿瘍の1例

Abstract

48歳女.主訴は発熱, 左側腹部痛.重篤な糖尿病であり, CTでは左腎周囲の多量の気腫と膿瘍と思われる液体貯留を認めた.DIPにては左腎を取り囲む多量のガス像を認め, 左腸腰筋の輪郭が不明瞭であったが結石や尿路の通過障害は認めなかった.入院時より抗生剤(セフォゾプラン)及びγグロブリン投与を行い, 食事は1200kcal/日とし, インスリンを用いた糖尿病の治療を開始した.入院後5日間保存的治療にても, 39℃台の発熱が軽快しない為, 全身麻酔下に左肋骨弓下に約5cmの切開を行いドレナージを行った.ドレナージ約2ヵ月後のCTでは, 左腎周囲の膿瘍は殆ど認められなくなった

A 48-year-old woman was referred to our hospital with high fever and left flank pain. She was diagnosed with diabetes mellitus (DM), and abdominal computed tomography (CT) revealed left perinephric abscess with much emphysema. She underwent drainage of the abscess by left flank incision after treatment with antibiotics and insulin. The pus culture revealed Escherichia coli. Immediately after drainage, the symptoms began to subside. At three months after drainage, abdominal CT revealed no emphysema around the left kidney. At 18 months after the discharge, left perinephric abscess was not seen and DM was well controlled with insulin.