腎自然破裂をきたした先天性水腎症

A case of spontaneous rupture of congenital hydronephrosis

　症例は44歳，男性。20年前より先天性左腎盂尿管移行部狭窄症を指摘されていたが放置。くしゃみとともに左腹部，背部痛をきたし当院救急外来を受診。CT所見より水腎の縮小と腎周囲に著明な液体貯留像を認め，水腎症の自然破裂の診断で緊急手術を行った。腎実質は菲薄化され，腎上極に12mmの裂孔を認めた。菲薄化され脆弱した腎実質にくしゃみによる急激な腎盂内圧の上昇が加わって破裂をきたしたものと考えられた。

　A 44-year-old man with congenital the ureteropelvic junction stenosis untreated for 20 years,presented to our emergency department with sudden left abdominal and back pain on sneezing. CT revealed regression of the hydronephrosis and a fluid collection around the kidney,so the patient underwent emergency surgery under a diagnosis of spontaneous rupture of hydronephrosis. The renal parenchyma was thin and a 12-mm ruptured hole was observed in the upper pole of the kidney,which seemed to have made after a rapid increase of intrapelvic pressure induced by sneezing.