膀胱－結腸瘻管：病例報告

Vesico-Colic Fistula – A Case Report

黃俊傑(Jiuun-Jey Huang) ； 張世忠(Shl-Chung Chong)

《慈濟醫學雜誌》 5卷1期 (1993/03) Pp. 47-51

https://doi.org/10.6440/TZUCMJ.199303.0047

摘要

病人為一74歲男性，入院之主訴為在兩個月前發現小便中含有似糞便樣的物質，同時解小便時有氣尿情形(pneumaturia)。住院接受一系列的檢查，包括膀胱鏡、大腸鏡、鋇劑灌腸攝影、骨盆腔電腦斷層掃描、靜脈腎盂攝影等，確定為一乙狀結腸與膀胱間之瘻管，其可能的原因為乙狀結腸憩室炎。經單一階段手術治療(one stage procedure)後痊癒出院。
一般而言，此類乙狀結腸－膀胱瘻管為一不常見之疾病，且以老年男性為多。在女性則因為子宮之屏障而有較低的發生率。診斷主要依據臨床症狀，內視鏡及放射線檢查；治療則根據瘻管的成因及所在位置而有不同的處理方式，但仍以外科治療為主，本文針對此病例之診斷及治療過程提出討論。

關鍵字

氣尿症 ； 憩室炎 ； 糞尿症 ； 膀胱－結腸瘻管

並列摘要

Vesicocolic fistula is an uncommon finding in urological practice. We report a case of 74 year-old male patient who was suffered from stool contaminated urine about 1-2 months prior to this admission. Mictional suprapubic discomfort and pneumaturia were also complained of. No definite laboratory finding was elicitable except leukocytosis in CBC and turbid and foul smelled urine in urinalysis. Cystoscopy disclosed some yellowish fecal material retained in a convergent mucosal tract at the dome of the urinary bladder. Barium enema demonstrated the presence of a vesicocolic fistula whereas pelvic CT scan illustrated diverticulosis at sigmoid colon. Neither abscess formation nor bowel obstruction was shown in radiologic studies. Sigmoidoscopy revealed multiple reddish patches scattered throughout the rectum above the anal verge and up to 10 cm level and a diverticulum about 1.0 cm in diameter was noted at 25 cm above anal verge. The definite diagnosis of vesicocolic fistula was attained mainly by barium enema, cystoscopy and pelvic CT scan. One-stage procedure with complete excision of the fistula tract and a small cuff resection together with good drainage of the bladder is preferable for the management of the fistula, provided the local condition is permitting. Pelvic CT scan revealed the existence of the fistula indirectly. The patient was cured without major complications.

並列關鍵字

pneumaturia ； fecaluria ； vesico-colic fistula ； diverticulosis