クローン病による直腸尿道瘻

Rectourethral fistula in Crohn's disease

　患者は48歳，男性。発熱，膿尿のため当科を受診した。直腸診にて直腸前壁に陥凹を触知した。大腸鏡にて同部に瘻孔を認めた。その後糞尿となり，バルーンカテーテルを留置した。尿道撮影，尿道鏡にて，前立腺部尿道に瘻孔を確認した。腸閉塞，下血のため緊急手術となり，結腸左半切除，人工肛門造設術を行った。発症1年5か月後尿道痛のため膀胱瘻を造設した。本邦4例目の直腸尿道瘻症例である。

　A 48-year-old male was referred to our clinic because of fever and pyuria. On rectal digital examination,a hollow was palpated in the anterior wall of the rectum,which proved to be a fistula by colonoscope. Subsequently fecaluria developed and urethral catheter was indwelled. The fistula was confirmed in the prostatic urethra by urethrography and urethroscope. Due to the development of ileus and bloody bowel discharge,left hemicolectomy and colostomy were performed on an emergent basis. One year and 5months after the onset of the disease,cystostomy was established because of urethral pain. This is the 4th case of the rectourethal fistula reported in Japan.