体外衝撃波結石破砕術後の予期せぬ合併症：骨盤性尿路感染症

An Unexpected Complication After Extracorporeal Shock Wave Lithotripsy: Emphysematous Pyelitis.

• Kamil Gokhan Seker
• Yusuf Arikan
• Yurdagul Cetin Seker
• Deniz Noyan Ozlu
• Ismail Evren

抄録

発汗性尿路感染症（UTI）は、ガス形成性の生物によって引き起こされる生命を脅かす疾患である。腎性尿路感染症（UTI）は、腎集水系のみでガスが形成されることを特徴とする稀な急性細菌性尿路感染症です。高血圧以外に合併症のない81歳女性患者を対象に，左腎骨盤内10mmサイズの結石に対して体外衝撃波結石破砕術（ESWL）を施行した．治療後10時間目に発熱と左脇腹痛を訴えて救急外来を受診した．非造影CT（NCCT）検査で左腎集血系にガスが認められた．EPと診断されたため，ワイドスペクトル抗生物質を投与し，左腎骨盤にネフロストミーカテーテルを留置した．ESWL後に発熱と脇腹痛を呈した患者にはEPを考慮し、NCCTを実施して検査を行うべきであると考えられた。

Emphysematous urinary tract infections (UTI) are life-threatening conditions caused by gas-forming organisms. Emphysematous pyelitis (EP) is a rare, acute bacterial UTI characterized by gas formation only in the renal collecting system. Extracorporeal shock wave lithotripsy (ESWL) treatment was performed for 10-mm sized stone in the left renal pelvis in an 81-year-old female patient with no known comorbidities other than hypertension. In the 10th hour following ESWL treatment, the patient referred to the emergency department with fever and left flank pain. Gas was noticed in the left renal collecting system in non-contrast computed tomography (NCCT). A wide spectrum antibiotic was given to the patient due to EP diagnosis and a nephrostomy catheter was placed in the left renal pelvis. EP should be considered in the patient with fever and flank pain after ESWL and NCCT should be performed for further examination. Quick diagnosis, examination and treatment of these patients in the emergency department are important.

Copyright © 2020, Seker et al.