エンドトキシン吸着治療後待機的に腎摘除術を施行した気腫性腎盂腎炎

Emphysematous pyelonephritis patients who underwent nephrectomy after endotoxin adsorption therapy

61歳，女性。既往歴，糖尿病。全身倦怠感，悪心嘔吐を主訴に近医受診。左気腫性腎盂腎炎によるショック状態と診断され，当院へ救急搬送して入院となる。KUB，腹部CTで左腎全体がガスで置換されており，櫛状の構造を確認できた。エンドトキシン吸着，抗生剤投与，開放ドレナージで炎症反応は改善した。第39病日に左腎摘出術施行。術後5日目にドレーン抜去，術後10日目に退院となった。

　A 61-year-old woman with a history of diabetes, Complainning general malaise, nausea and vomiting was admitted to our hospital. She was diagnosed as a state of shock due to left emphysematous pyelonephritis by a nearby physician. KUB and abdominal CT showed a comb-like structure of the entire left kidney replaced with gas. We performed endotoxin adsorption therapy with open drainage, and antibiotics. After inflammatory response has been improved left nephrectomy was performed on 39th hospital day. Postoperative 5th day, the drain was removed. She was discharged on postoperative 10th day.