外傷性尿管断裂の1例

INJURY OF THE URETER DUE TO EXTERNAL VIOLENCE:A CASE REPORT

緒言

　われわれが遭遇する尿管外傷は骨盤内臓器を対象とする手術の際の偶発症として起こるものや，尿管カテーテリスムス時における人為的なものが多く，外力による尿管外傷は珍しいとされている。したがつて，外傷の患者が血尿や側腹痛などを訴えた場合，われわれはまず腎外傷を考え保存的に観察する場合が多い。しかし，われわれは最近，血尿・側腹痛などを訴えたため腎外傷と考え手術時機を逸し，腎摘除術を行なわざるを得なかつた尿管断裂の1例を経験したので報告する。

A 39-year-old male suffered from blunt trauma by a mass of concrete on his lower abdomen at work. X-ray showed fracture of the pelvic bone. He complained of pain in the right flank and upper quadurant of the abdomen. Gross hematuria was noticed on the first day. Intravenous pyelography revealed leakage of the contrast medium around the ureteropelvic junction. The right ureter could not be catheterized beyond the level of 2 cm below the ureteropelvic junction. Incision and drainage of the right flank 17 days after the accident produced a large volume of cloudy urine. The right kidney and ureter were explored 56 days after the accident.