暴走した腎臓：腎臓部分ヘルニアを伴う傍流ヘルニアの稀な症例

The runaway kidney: a rare case of a parastomal hernia with partial kidney herniation.

• Jonathan B Livezey
• Alexa M Bolock
• Timothy J Farrell

抄録

吻合部ヘルニアはオストミー形成時によくみられる合併症であるが、腸以外の腹腔内臓器のヘルニアはまれである。また、腎臓などの後腹膜臓器のヘルニアは極めて稀な症例である。尿路感染症を合併して急性腎障害を呈した59歳男性の症例を報告する。CTスキャンの結果，左近位尿管結石に左水腎症を合併し，腸間膜/腹膜脂肪，右腎臓の一部，右近位尿管，腸の一部にヘルニアを伴う顕著な右副腎ヘルニアを認めた．患者は手術室に運ばれ、ステント留置を伴う左膀胱鏡検査を受け、全快した。患者の広範な手術歴、術後感染のリスクが高いこと、右腎臓の機能障害を示すエビデンスがないことから、現時点では外科的介入は推奨されなかった。

Although parastomal hernias are a common complication of ostomy formation, herniation of intra-abdominal organs, aside from intestine, is infrequent. Furthermore, herniation of retroperitoneal organs, such as the kidney, is an extremely rare finding. We report the case of a 59-year-old male with a right ileostomy who presented with an acute kidney injury with suggestive urinary tract infection. A computed tomography scan revealed a left proximal ureteral stone with left hydronephrosis and a prominent right parastomal hernia with herniation of the mesenteric/retroperitoneal fat, portion of the right kidney, right proximal ureter and some bowel. The patient was taken to the operating room for a left cystourethroscopy with stent placement and made a full recovery. Due to the patient's extensive surgical history, high risk of postoperative infection and lack of evidence demonstrating functional impairment of the right kidney, surgical intervention was not recommended at the present time.

Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author(s) 2020.