尿管大動脈瘻の1例

Abstract

骨盤内容除去術及び右下腹部での二連尿管皮膚造瘻術が行われた直腸癌の69歳男で, 尿管瘻狭窄の為にdouble J stentの二尿管内持続留置を必要とした.術後2年にdouble Jカテーテル交換中に大出血が起こった.閉塞性尿管造影上, 左尿管と大動脈との交差点で尿管大動脈瘻が認められた.大動脈瘻を縫合閉鎖し, 瘻の近位側で左尿管を結紮し, 左経皮的腎瘻術を造設した.4年余の現在, 再発なく健在である

We report a case of uretero-aortic fistula. A 69-year-old man with rectal cancer underwent a pelvic exenteration and a double--barreled cutaneous ureterostomy in the right lower abdomen. Stomal stenosis necessitated continuous indwelling of double J stents in the two ureters. Two years postoperatively, massive bleeding occurred during exchange of double J catheters. Occlusive ureterogram demonstrated a uretero-aortic fistula at the crosspoint between the left ureter and the aorta. The surgical repair consisted of closure of the aortic fistula, ligation of the left ureter proximal to the fistula and percutaneous left nephrostomy.