症例報告
腹腔鏡下子宮全摘出術中、尿管損傷が疑われたが、術後に先天性単腎症が明らかとなった1例
2018 年 34 巻 1 号 p. 108-111
詳細
2018 年 34 巻 1 号 p. 108-111
Background : Uterine malformations frequently coexist with an abnormality in the renal urinary tract system. We report a case of uterus bicornate unicollis in which ureteral injury during surgery was suspected but congenital unilateral renal aplasia was eventually diagnosed.
Case : A 42-year-old woman with uterus bicornate unicollis accompanied by uterine leiomyoma with anemia underwent total laparoscopic hysterectomy after administration of a GnRH agonist. Following the hysterectomy, cystoscopy was performed with intravenous injection of indigocarmine, and neither outflow of indigocarmine nor the right ureteral orifice was confirmed. We suspected a ureteral injury and checked the right ureter but did not observe an enlarged ureter or urine leakage into the abdominal cavity. We consulted a urologist, but the right ureteral orifice could still not be identified and the right kidney could not be identified by ultrasonography. After surgery, abdominal contrast-enhanced CT was performed, and the right kidney was not recognized. The patient's renal function was normal and her postoperative course was good. The patient had been diagnosed with uterus bicornate unicollis, but we did not evaluate the renal urinary tract system by a method such as drip infusion pyelography before surgery.
Conclusion : We reconfirmed the importance of carefully examine the renal urinary tract system before surgery in the cases with uterine malformations.
If urinary excretion cannot be confirmed by intraoperative cystoscopy, while rare, the possibility of kidney deficiency and other malformations should be considered.
