難治性会陰部尿道皮膚瘻を伴った臀部慢性膿皮症の1例

Abstract

65歳男, 1)臀部慢性膿皮症を伴った難治性会陰部尿道皮膚瘻に対し, 抗結核療法後に複数の外科的治療を施行し良好な結果がえられた. 2)尿路の瘻孔に続発した臀部慢性膿皮症の報告は本邦初である. 3)複雑な尿道狭窄及び瘻孔は, 結核病変の可能性も念頭において初期治療を誤らないことが重要である

A 65-year-old male was hospitalized because of micturition pain and urinary oozing from several fistulas on the perineal and the left gluteal skin. Oozing had been present for about 50 years, after receiving mass resection of his left scrotum or perineum, and left orchiectomy. The main focus was on the left dorsal site of the anus. Compression around this area produced malodorous grayish pus discharge from many fistulas, although the anus was intact. Although he had histories of spinal caries and renal tuberculosis, both pus and urine cultures showed Staphylococcus spp. and no growth of Mycobacterium tuberculosis. Urethrocystography showed urethral stenosis at bulbar urethra and leakage from a site just proximal to the stenosis. Antibiotics for tuberculosis were administrated for fear of recurrent tuberculosis for 6 months. Cystostomy formation and debridement were performed, followed by en-bloc resection and mesh-skin graft after two weeks. Internal urethrotomy was performed six months after the surgery, and subsequently cystostomy removed. After three and a half years, although there was no local recurrence and no difficulty of urination, he died of cholangio-carcinoma. There are many reports of chronic perianal pyoderma subsequent to hemorrhoid or subcutaneous abscess; however, this might be the first report on a case originating from fistulas in the urinary tract.