内腸骨動脈りゅう自然破裂による尿管動脈ろうの１例

Abstract

We report the case of a fistula between a left internal iliac artery aneurysm and the left ureter. An 86-year-old man with no history of laparotomy was hospitalized after collapsing because of sudden massive hematuria. Abdominal computed tomography (CT) showed an abdominal aortic aneurysm and bilateral internal iliac artery aneurysms, necessitating emergency laparotomy under a presumptive diagnosis of urinary bladder hemorrhage. No evidence was seen of active bleeding from the ureter or bladder and massive hematuria was not seen until postoperative day (POD) 52. A second laparotomy and ureterectomy with repair of the fistula was undertaken after cystoscopy led to a diagnosis of left ureteroarterial fistula. Postoperatively, the right internal iliac artery aneurysm spontaneously rupturted into the intraperitoneum on POD 43 and the third operation was successful. The man died of acute heart and renal failure and severe bronchial asthma on POD 45 after the last operation. Ureteroarterial fistula caused by spontaneous rupture of an aneurysm is extremely rare. Only 2 cases have been described through 2001 and to the best of our knowledge this is the first such report in the Japanese literature. Preoperative diagnosis is difficult, but heavy hematuria in a patient with or without prior surgery or ureteral stenting may suggest to the clinician the possibility of ureteroarterial fistula.