回腸導管内に形成された巨大な結石

A case of large stone in ileal conduit

　症例は71歳，男性。1960年代に膀胱癌のため根治的膀胱全摘除術，回腸導管造設術を施行された。今回，発熱，下腹部痛にて受診し，2個の回腸導管内結石，腹壁瘢痕ヘルニアとパラストーマヘルニアを認めた。開腹下に結石摘出術およびヘルニア修復術を施行した。結石は10.5×5.3cm重量365g，5.5×4.3cm重量120gの2個であった。文献上検索しえた限りでは，最も巨大な回腸導管内結石であった。

A 71-year-old man with large stones in the ileal conduit was referred to our institution for high fever and lower abdominal pain. He had undergone total cystectomy with ileal conduit urinary diversion for bladder cancer about 40 years before,and had not postoperative regular check. Radiological examinations showed two large stones in the ileal conduit,parastomal hernia and lower abdominal incision hernia. We performed open surgery to remove the stones from the ileal conduit and restore parastomal and incisional hernias. The larger stone weighed 365g and measured 10.5×5.3cm,and the other one weighed 120g and measured 5.5×4.3cm. Analysis of the stones revealed magnesium ammonium phosphate and carbonate apatite. The stones were found to contain an unabsorbable nylon suture thread. To our knowledge,present case had the largest stone in the ileal conduit ever reported in the literature.