腹部大動脈瘤による両側尿管通過障害の1例

Abstract

A case of bilateral ureteral obstruction secondary to abdominal aortic aneurysm presenting as renal failure was reported and the literature was reviewed. A 61-year-old man was admitted because of abdominal pulsatile mass and renal failure. Urinary volume was sufficient. He hadn't been suffering from flank pain. BUN was 62 mg, and serum creatinine creatinine was 4.2 mg. Aortography revealed calcified, saccular aneurysm in the midportion of abdominal aorta and in the common iliac artery. Both ureters were catheterized without obstruction and hydronephrotic drip was gained. Then bilateral hydronephrosis with medial deviation of the ureters was identified. After indwelling the ureteral catheters for 16 days, BUN decreased to 34 mg, and serum creatinine to 2.5 mg. Computed tomography revealed catheterized ureters encased in the perianeurysmal fibrous tissue. Dacron prosthesis was placed in the opened aneurysmal cavity. Left ureter was dissected freely from fibrous tissue and fixed laterally with peritoneum. Right one couldn't be dissected completely. Histological examination of the aneurysmal wall showed fibrous tissue infiltrated with mononucleal cell such as lymphocyte and plasma cell without any hemosiderin-laden macrophage. IVP 3 months post-operatively showed marked improvement of left hydronephrosis but only considerable resolution on the right side. The renal function returned to normal.