尿管カテーテル交換中に尿管大動脈瘻をきたした1例

Abstract

44歳男性。患者は29歳時に他科で右精巣腫瘍・後腹膜リンパ節転移に対する集学的治療施行後, 尿管狭窄を来し尿管カテーテルを留置された。今回, 尿管ステントの定期的交換中に肉眼的血尿, 貧血が出現し, 著者らの施設へ受診となった。単純CTなど精査の結果, 尿管カテーテル交換操作が誘因となったDJカテーテルによる尿管大動脈瘻と診断され, 瘻孔の縫合閉鎖および腎瘻造設が行なわれた。術後は経過良好で, 現在, 紹介先クリニックにて経過観察中である。

We report a case of a patient with a fistula between the left ureter and abdominal aorta. The patient was a 44-year-old male who had undergone radiation therapy (intraoperative: 25 Gy, external beam: 50 Gy) and chemotherapy (CDDP: 250 mg) for retroperitoneal lymph node metastasis from seminoma. His postoperative course was complicated by stenosis of bilateral ureters, which were treated by indwelling double J-stents. Fifteen years after the operation, gross hematuria occurred from the left ureteral orifice when exchanging the left ureteral double J-stent. Computed tomographic scan demonstrated left ureteral-abdominal aortic fistula formation at the crossing point. Massive hemorrhage was suspected to have prompt fistula formation between the left ureter and the aorta. At exploration, there was a fistula of about 7 mm in diameter at the anterior surface of the aorta, and the stent was presumably inserted from it. The aortic fistula was successfully closed. In addition, the left ureter was ligated proximal to the fistula and percutaneous left nephrostomy were performed. His postoperative course was uneventful. We should be aware that uretero-arterial fistula can occur as a serious complication of ureteral catheter exchange after prolonged ureteral stenting and radiation therapy.