直腸癌に対し骨盤内臓器全摘術施行後大動脈尿管瘻を形成した1例  [in Japanese] A CASE OF AORTOURETERAL FISTULA AFTER TOTAL PELVIC EXENTERATION FOR RECTAL CANCER  [in Japanese]

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Abstract

直腸癌に対し骨盤内臓器全摘術施行後,大動脈尿管瘻を形成した1例を報告した.<br> 症例は72歳,男性.直腸癌にて骨盤内臓器全摘術施行後,尿管皮膚瘻より拍動性の出血を認めた.逆行性尿路造影,血管造影などの諸検査を行うも出血部位は確認できなかった.出血は尿管カテーテル挿入による圧迫にて一時的に止血は得られたが,繰り返す大量出血のため緊急手術を行った.開腹所見では,左尿管が大動脈前面を横切る部位で大動脈壁と高度に癒着しており,同部位で瘻孔を形成していた.手術は壊死部の大動脈の血管壁を切除し人工血管によるパッチにて修復,さらに有茎大網を用いて同部の被覆を行った.敗血症から播種性血管内凝固症候群(DIC)を併発し,術後第7病日にパッチ部の縫合不全による腹腔内出血にて死亡した.<br> 動脈尿管瘻は稀な疾患であるが,その可能性を考慮し,早期に診断して,適切な治療を行うことが重要であると考えられた.

This paper describes a case of aortoureteral fistula after a total pelvic exenteration for a rectal cancer.<br> A 72-year-old man who had undergone a total pelvic exenteration for a rectal cancer 70 days before developed massive bleeding from the cutaneous ureterostomy. Retrograde ureterography and arteriography failed to show the site of bleeding. Because of repeating massive bleeding, an emergency operation was performed. Surgical exploration demonstrated an aortoureteral fistula at the region where the left ureter crossed the abdominal aorta. He was treated with en bloc resection of the aortoureteral fistula and repair of the aorta with Dacron patchplasty, which was protected by viable greater omentum. But he died of bleeding from patchplasty region at the 7th postoperative day, because of disseminated intravascular coagulation syndrome from sepsis.<br> We believe that an attention for this rare condition is crucial for early diagnosis and prompt treatment.

Journal

  • The journal of the Japanese Practical Surgeon Society

    The journal of the Japanese Practical Surgeon Society 58(9), 2157-2161, 1997-09-25

    Japan Surgical Association

References:  12

Cited by:  2

Codes

  • NII Article ID (NAID)
    10008530591
  • NII NACSIS-CAT ID (NCID)
    AN00198696
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    03869776
  • Data Source
    CJP  CJPref  J-STAGE 
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