両側腸腰筋膿瘍と化膿性脊椎炎を合併した前立腺膿瘍

Prostate abscess with bilateral iliopsoas abscess and pyogenic spondylitis : A case report

　67歳男性．腰背部痛で受診，採血検査で炎症反応は強陽性であった．腹部CTで両側腸腰筋膿瘍，前立腺膿瘍，腰椎MRIで化膿性脊椎炎を認めた．開腹にて両側腸腰筋膿瘍ドレナージ術，膀胱瘻造設術を施行した．前立腺膿瘍に対しては経尿道的ドレナージ術を行った．経尿道的ドレナージから7日後，両下肢麻痺を認めた．MRIで化膿性脊椎炎の増悪を認め，椎弓除圧術が施行された．術後，自力歩行可能，膀胱瘻抜去となった．

Abstract

A 67-year-old male complaining of a lumbar backache was examined at our hospital. Blood tests revealed sever inflammatory response. An abdominal computed tomography (CT) scan revealed bilateral iliopsoas and prostatic abscesses. Additionally, a lumbar magnetic resonance imaging (MRI) showed high intensity lesion at the 4th and 5th lumber vertebraand first sacral vertebra, indicating pyogenic spondylitis. Subsequently, bilateral iliopsoas abscess drainage and cystostomy were performed, and transurethral drainage was performed for the prostatic abscess. Seven days after the transurethral drainage, paralysis of both lower limbs was observed. An MRI scan revealed an exacerbation of pyogenic spondylitis ; therefore, decompression of the vertebral arch was performed. After the surgery, a bladder fistula was removed, and the patient was able to walk independently (Rinsho Hinyokika 74 : 249-252, 2020).