尿管皮膚瘻に合併した尿管大動脈瘻の1例  [in Japanese] A CASE OF URETERO-AORTIC FISTULA AFTER THE URINARY DIVERSION  [in Japanese]

症例は, 84歳男性.1991年9月4日, 膀胱上皮内癌に対し膀胱全摘術, 右側一側開口両側尿管皮膚瘻造設術を施行した.以後, 透視下に両側尿管留置カテーテルを定期交換していたが, カテーテル定期交換から約1カ月後の2003年11月3日, 尿管皮膚瘻から大量出血を来し出血性ショックとなった.CTでは, 左尿管が腹部大動脈瘤(5×6cm)と接して横断しており, 腎盂内には高吸収像が充満していた.左尿管と腹部大動脈瘤が交通し, 腎盂内に血液が充満していると考えられた.腹部大動脈瘤, 左尿管大動脈瘻と診断し, 腹部大動脈人工血管置換術, 左腎瘻造設術を施行した.3日後の2003年11月6日, 虚血性大腸壊死を併発したため, 左半結腸切除, 横行結腸瘻造設, 脾臓摘除術を施行した.術後尿量は保たれ腎不全の悪化は回避されたが, 3カ月後に消化管出血, 多臓器不全のため永眠した.

We report a case of a patient with a fistula between left ureter and abdominal aorta. The patient was a 84-year-old male who had undergone total cystectomy with a single stoma cutaneous ureterostomy for the treatment of transitional cell carcinoma of the bladder. His postoperative course was complicated by stenosis of the stomal orifices, which was treated with two silicone tubes. Twelve years after the operation, massive arterial bleeding occurred from the cutaneous ureterostomy, which was caused by left ureteral-abdominal aortic aneurysm fistula due to prolonged ureteral stenting. Graft replacement for abdominal aortic aneurysm and percutaneous left nephrostomy were performed, but he died 3 months following the operation due to multiple organ failure. Ureteroarterial fistula after the urinary diversion can occur in association with prolonged ureteral stenting, radiation therapy, and vascular pathology. Identification of a fistula is often difficult and requires the physician to be highly alert and vigilant.