腎盂結石の治療を契機に診断された膀胱虫垂瘻

Vesicoappendiceal fistula detected during the treatment of renal pelvic calculus：A case report

症例は58歳，男性。右側尿管結石嵌頓による急性腎盂腎炎を加療後，2008年1月，結石加療を目的に当科紹介，糞尿を認めたため，精査入院となった。11年前以降，気尿を伴なう反復する膀胱炎の既往を有していた。膀胱鏡検査で，膀胱頂部右側の瘻孔より糞便の流入を，膀胱造影検査で回盲部，上行結腸への造影剤の流出を認めた。以上より膀胱腸瘻の診断で，外科の協力を得て腹腔鏡補助小切開手術を施行した。組織学的所見により，虫垂憩室による膀胱虫垂瘻と診断した。本邦における膀胱虫垂瘻の報告は，現在まで50例があり，本症例は51例目にあたると思われる。

A 58-year-old man,after receiving treatment for acute pyelonephritis caused by impaction of right ureteral stone,was refferd to our department for further treatment of the stone in January 2008. However,fecaluria was found which caused him to be hospitalized for close investigation. For the past 11 years,the patient has had a history of repeating cystitis with pneumaturia. In cystoscopic examination,outflow of fecaluria from the fistulae of the top of the right-sided bladder was found. In bladder contrast study,outflow of contrast agent into ascending colon was demonstrated. Under the diagnosis of vesicointestinal fistula,we performed laparoscopic assisted small incision surgery. Diagnosis of vesicoappendiceal fistula caused by appendiceal diverticulum was made by histological observation. This case seems to be the 51st case of vesicoappendiceal fistula in Japan.