尿膜管嚢胞への嵌入による絞扼性腸閉塞の1例 A CASE OF STRANGULATED ILEUS DUE TO INCARCERATION TO THE URACHAL CYST

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Abstract

59歳の男性で,腹痛を主訴に来院した.腹部単純X線所見などから腸閉塞と診断し,イレウスチューブを挿入して減圧したが,症状は改善しなかった.並行して進めた腹部超音波, CT検査にて膀胱上部正中で腹壁に接した約5cmの嚢胞状の腫瘤が存在し,内腔には腸管を認めた.腹腔内へ開口した嚢胞への小腸の嵌入による腸閉塞の診断にて開腹したところ,膀胱上部に尿膜管嚢胞が存在し,その一部が穿破して嚢胞内へ回腸が嵌入を起こし絞扼されていた.嚢胞と絞扼回腸の切除術を施行した.術後経過良好で軽快退院した.尿膜管嚢胞の合併症は,感染がほとんどであり,腸閉塞を合併することはまれと考えられ,尿膜管嚢胞との炎症性の癒着性腸閉塞の報告が散見されるのみである.腸閉塞の原因が尿管膜嚢胞内への嵌入であった症例は極めて稀で,検索した限り自験例が1例目と思われる.

A 59-year-old man was admitted to the hospital because of an abdominal pain. On plain abdominal X-ray examination he was diagnosed as intestinal obstruction. Although an ileus tube was inserted, symptoms became worse. A cystic structure above the urinary bladder was identified by abdominal CT scan and echography. It was about 5 cm in diameter and the ileum was incarcerated in this cavity. Operation was carried out for a suspicion of intestinal obstruction due to hernia. A cyst below the navel was found to be included in a cord connecting to the urinary bladder. The ileum was incarcerated in this cavity causing hernia. The cyst including the wall of the urinary bladder and the injured ileum were resected with the operative diagnosis of strangulated ileus due to incarcerated hernia to the perforated urachal cyst. The postoperative clinical course was uneventful. The urachal cysts are often associated with infection, but uncommonly with intestinal obstruction. Only a few cases of adhesive ileus with infected urachal cyst have been reported, but this case seems the first report as causing intestinal obstruction due to hernia to the urachal cyst.

Journal

  • The journal of the Japanese Practical Surgeon Society

    The journal of the Japanese Practical Surgeon Society 57(6), 1403-1406, 1996

    Japan Surgical Association

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