腫瘤形成性膵炎を伴い寛解と再発を来した後腹膜線維症

A CASE OF RETROPERITONEAL FIBROSIS WITH TUMOR FORMING PANCREATITIS

　症例は63歳，男性。両側腰背部痛，食欲不振を主訴として受診。腎超音波検査にて左水腎症，腹部CT検査にて傍大動脈領域に軟部腫瘍像が認められたため後腹膜線維症と診断された。治療として尿管カテーテルを留置するとともにプレドニゾロン10mgの投与を開始した。経過観察中に腫瘤形成性膵炎を併発し手術を施行，治癒するも後腹膜線維症はプレドニゾロン投与中止により再発を認め，さらに再投与により寛解を来すため，現在も外来にて厳重に経過観察中である。本症例は慢性膵炎の一病型である腫瘤形成性膵炎発症以前より後腹膜線維症の発症を認めているが，慢性膵炎自体，診断が困難な場合もあることより，慢性膵炎に続発した後腹膜線維症である可能性も否定できない。

The patient was a 63 year-old man whose chief complaints were bilateral dorsolumbar pain and loss of appetite. Left hydronephrosis was found by ultrasonogra-phy and soft tissue mass around the aorta was found by abdominal CT examination. The patient was diagnosed as retroperitoneal fibrosis and was treated with indwell-ing ureteral catheter and 10 mg of predonisolone. During the course of observation, the patient became icteric and tumor-forming pancreatitis was diagnosed, for which operation was performed. Though the patient became free of jaundice retroperitoneal fibrosis recurred after stop of predonisolone.