S状結腸癌に伴ったS状結腸膀胱瘻

A case of sigmoid colovesical fistula caused by a foreign body granuloma following a sigmoid colon cancer

　症例は72歳，男性。糞尿の原因精査および加療目的に当院に紹介され入院となった。CT，MRIにて膀胱に浸潤するS状結腸腫瘍を認め，大腸内視鏡ではS状結腸の全周性狭窄を認めた。膀胱鏡にて膀胱後壁の浮腫状変化を認めた。S状結腸癌，S状結腸癌の膀胱浸潤によるS状結腸膀胱瘻を疑い，S状結腸切除術，膀胱部分切除術を施行した。病理組織学的にはS状結腸癌，S状結腸癌膀胱浸潤と，それとは別部位に炎症性S状結腸膀胱瘻を認めた。

　A 72-year-old man with the chief complaint of pollakisuria,miction pain and fecaluria was referred to our hospital. CT,MRI,cystoscopy and colonoscopy with biopsy revealed the sigmoid colon cancer and the sigmoid colovesical fistula. Under the diagnosis of bladder invasion of the sigmoid colon cancer,sigmoidectomy and partial cystectomy were performed. Histologically,the resected sigmoid colon tumor showed moderately differentiated adenocarcinoma with fistula formation to urinary bladder. The carcinoma involving the deep subserosa and the adventitia of the adhered urinary bladder were observed,however,in the fistula wall,many foreign bodies（fish bones and seeds）were embedded and marked inflammation with foreign body granulatoma formation were noticed.（Rinsho Hinyokika 61：453-455,2007）