自然発生腎盂十二指腸瘻の1例

Abstract

結石を有する無機能腎の反復する腎盂腎炎が原因と思われる自然発生腎盂十二指腸瘻の1例を経験した. 1)右腎摘出を予定したが周囲組織との癒着が高度の為, 十二指腸部分切除・横行結腸合併切除術を行い, 右腎盂十二指腸瘻と診断した.組織所見より, この瘻孔は腎盂腎炎が十二指腸に穿通したものと思われた. 2)本例は本邦文献上の15例目の自然発生腎盂十二指腸瘻と思われた. 3)本疾患の治療として, 腎摘出・瘻孔閉鎖術が広く行われているが, 腎機能良好例に対しては腎温存療法を考慮する必要がある

A 71-year-old female presented with recurrent episodes of right flank pain and fever for the past several years. No pathogens were detected in the urine culture. Abdominal X-ray revealed staghorn calculi of the right kidney. Computerized tomography revealed pneumopelvis and staghorn stones of the right kidney. A nephrectomy was indicated based on the results of intravenous pyelography (IVP) and renogram which revealed a right non-functioning kidney. The adhesion of the right kidney with the duodenum and a transverse colon was so strong that a nephrectomy, a wedge resection of the duodenum and a transverse colectomy were performed. There was a fistula between the renal pelvis and the second portion of the duodenum. The fistula was speculated to have occurred by the spontaneous rupture of the renal pelvis to the duodenum. To the best of our knowledge, this is the 15th case of spontaneous nephroduodenal fistula in Japan.