尿管自然破裂をきたした転移性尿管腫瘍の1例

Abstract

Spontaneous rupture of the right upper ureter caused by metastatic ureteric tumor in an 80-year-old man is reported. He was admitted to our hospital with right lower abdominal pain. Ultrasonography showed mild right hydronephrosis and a low echogenicity mass under the right kidney. Drip infusion pyelography and abdominal computerized tomography showed extravasation of contrast medium around the right upper ureter. Retrograde pyelography was unsuccessful because of edema of the bladder wall. Right ureterocutaneostomy was performed under the diagnosis of spontaneous rupture of the right ureter. The right ureter was completely obstructed 3 cm below the point where it crossed the common iliac artery. At this site, the ureteric wall was hard, thickened, and adherent to the surrounding tissue. The lesion was a metastatic adenocarcinoma. The origin of the tumor could not be found, but pancreatic cancer was suspected on the basis of elevated CEA and PSTI levels. He died of peritonitis carcinomatosis at 8 months after surgery. Thirty three cases of spontaneous rupture of the ureter and 60 cases of metastatic ureteric tumor have been reported in Japan. However, our patient is the first reported case of spontaneous rupture of the ureter caused by a metastatic ureteric tumor in the Japanese literature.