術後22年目に多量出血を来した空置回腸環の1例

BLEEDING DUE TO RUPTURE OF VARIX FROM THE ILEAL LOOP USED IN SCHEELE'S ILEOCYSTOPLASTY

　78歳男性が肉眼的血尿にて来院。22年前に腎結核と結核性萎縮膀胱のため左腎摘出術およびScheele回腸環膀胱拡大術を受けている。膀胱鏡検査で膀胱に吻合した回腸環からの出血が認められた。血液検査上肝硬変症を伴つていた。回腸環内の悪性病変が強く疑われたため回腸環切除術を施行した。その結果，肝硬変症に伴う門脈圧亢進症により回腸環に静脈瘤が生じ，その破綻による出血であつた。

A 78-year-old man presented with a complaint of painless gross hematuria. He had left nephrectomy and ring loop ileocystoplasty about 22 years ago due to renal tuberculosis and bladder contracture. He noticed sudden gross hematuria in May, 1984. Bleeding from the ileal loop anastomosed to the bladder was observed by cystoscopic examination. Cystogram and CT scan revealed no abnormal findings except for marked dilatation of the isolated ileal loop. Abundant residual urine was observed in the ileal loop on postvoid cystogram.