尿管静脈瘤の1例

Abstract

Few reports have been made on varicosis which occurs around or in the wall of upper urinary tract. Only fourteen cases has been reported in Europe and America and no case was reported in Japan. This report deals with a case of varicosis seen in uretero-pelvic junction and upper portion of the ureter, and discussions were made on etiology, pathology, clinical findings and the treatment of such condition. A 14-year-old boy was admitted with asymptomatic hematuria of six months duration. He had been treated as acute nephritis at the other hospital. Family or past history was not contributory including stone, tuberculosis and trauma of the urinary tract. He had no remarkable physical signs on chest and abdomen. Neither abnormal dilatation of the abdominal vein nor varicocele was found. The blood pressure and blood sedimentation rate were normal. All the hematological tests were within normal range. Hepatic and renal fonction were unimpaired. Urinalysis showed albuminuria, hematuria, and pyuria, but no casts. Cystoscopy revealed that the urine excreted from left ureteral orifice was fairly bloody, but the urine from right side was clear. The bladder mucosa appeared normal. There was no stone on the plain film of the urinary tract. Excretory urogram showed irregular indentation and crenation on left uretero-pelvic junction and upper portion of the ureter. Abdominal aortogram including the nephrographic phase revealed no abnormalities. The patient was diagnosed as a suspect of multiple tumor of upper urinary tract, and operation was done. There was found dilated mesenteric veins of descending colon and varicosities were recognized at the region which accorded with the indentation and crenation on the excretory urogram. The varicosities were ligated and removed. Hematuria completely disappeared postoperatively. On the excretory urogram 3 weeks postoperatively, slight dilatation of renal pelvis and ureter was found, but no dilatation was found 3 months after the operation. His postoperative course was uneventful.