Crohn病による盲腸膀胱瘻の1例  [in Japanese] A CASE OF CECOVESICAL FISTULA ASSOCIATED WITH CROHN'S DISEASE  [in Japanese]

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Abstract

症例は32歳,男性.下腹部痛,膿尿が出現し,膀胱炎の診断にて治療を受けたが軽快せず当科受診した.注腸造影検査,大腸内視鏡検査にて虫垂入口部とBauhin弁の間に顆粒状隆起,ひだのひきつれを認め,膀胱造影検査にて膀胱頂部右側にひきつれを認めた.腹部MRI検査,超音波検査では膀胱頂部から上方へ連続する索状構造を認めた.以上より,臍尿膜管遺残,盲腸膀胱瘻を疑い,手術を施行した.開腹にて盲腸膀胱瘻,そして回腸縦走潰瘍を認め,回盲部切除,膀胱部分切除を施行した.臍尿膜管遺残は認めなかった.切除標本では回腸に25cmの縦走潰瘍を認め,また,盲腸の顆粒状隆起部に膀胱との瘻孔を認めた.病理組織学的に縦走潰瘍部に回腸壁全層の欠損,潰瘍底と瘻孔部に類上皮肉芽腫を認め, Crohn病とこれによる盲腸膀胱瘻と診断された. Crohn病による腸管膀胱瘻は比較的稀であり,文献的考察を加え報告する.

A 32-year-old man was referred to our hospital for closer examinations of lower abdominal pain and pyuria. Barium enema radiography and colonoscopy demonstrated a granular lesion with a fold concentration at the cecum. Cystography showed a deformity at the top of the bladder. Abdominal magnetic resonance imaging (MRI) and ultrasonography showed a funicular lesion from the top of the bladder. Surgery was conducted for suspected cecovesical fistula and patent urachus. Laparotomy showed a cecovesical fistula and longitudinal ileal ulcer necessitating ileocecal resection and partial bladder resection. Patent urachus was not observed. The resected specimen showed a 25cm longitudinal ileal ulcer and a cecovesical fistula. Histopathologically, the ileal ulcer reached the serosal layar and epitheliod garanulomas were detected at both the ulcer and fistular lesion. The diagnosis was cecovesical fistula associated with Crohn's disease. Enterovesical fistula due to Crohn's disease is relatively rare, and the case is reported with a review of the literature.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 63(6), 1537-1540, 2002-06-25

    Japan Surgical Association

References:  8

Cited by:  1

Codes

  • NII Article ID (NAID)
    10008914213
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    13452843
  • Data Source
    CJP  CJPref  J-STAGE 
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