新生児精巣捻転の1例

Abstract

An infant normally delivered at the 38th week of gestation was referred to our department one day after birth for a firm and painless right hemiscrotal mass with bluish coloration. Since contralateral scrotum showed swelling, we performed emergency surgery on that day. The right spermatic cord was constricted due to extravaginal torsion, and degree and direction of torsion was unclear since the spermatic cord was already organized. Right testis showed irreversible necrotic change, requiring orchiectomy. We confirmed that left testis was intact and performed orchidopexy. Since high incidence of contralateral asymptomatic torsion has been reported in patients with prenatal testicular torsion, emergency surgery should be considered when contralateral scrotum shows abnormal findings.

生後1日男児。生下時に陰嚢異常の指摘はなく、生後1日目に右陰嚢内容の硬結と陰嚢壁の黒色変化を認めて同日に当科受診した。圧痛、透光性は認めず、右陰嚢内容は挙上し、挙睾筋反射は消失し、対側の左陰嚢壁は浮腫状に腫大していた。超音波断層像で右精巣内部は不均一で左側に比べて萎縮しており、カラードップラーでは右精巣に血流を認めず、出生前精巣捻転と診断して同日に緊急手術を施行した。右精巣は出血壊死による黒色変化を伴い陳旧性の鞘膜外捻転の痕跡と考える精索のくびれを認めたが器質化進行により回転方向、角度とも不明で、精巣回復不能と判断して精巣摘除術を施行した。対側精巣に問題のないことを確認後に固定術を施行した。病理所見より精細管核はうっ血した血管を伴い変形し、陳旧性の変性壊死と診断した。