- 期刊
Perirenocolonic Fistula Caused by Perirenal Abscess Secondary to Perirenal Hematoma: A Case Report
續發於腎旁血腫之腎旁膿瘍所導致的腎旁結腸瘻管－病例報告
摘要
腎旁血腫合併腎旁膿瘍的情形不常見，而腎旁結腸瘻管是腎旁膿瘍更少見的併發症。我們報告一位73歲的婦女，呈現的症狀為輕微左側腰部酸痛一個月，而後被診斷為威脅生命的腎旁結腸瘻管。超音波導引下所抽取的腎旁物質呈現膿狀外觀，將此抽吸物做培養，結果呈現同時有Klebsiella pneumoniae、Pseudomonas aeruginosa、Enterococcus、Bacteroides fragilis、Peptostreptococcus 以及Candida albicans混合菌叢生長，因此懷疑在腎旁空間與胃腸道之間有瘻管形成。腹部電腦斷層以及下胃腸道鋇劑攝影被安排，顯示靠近脾曲部的降結腸與和左側腎旁空間之間有瘻管形成。經過清創、抗生素、結腸吻合術以及足夠的引流之後，病患逐漸痊癒。因爲腎旁膿瘍的症狀和實驗室檢查經常不具特異性，因此腎旁血腫應該被嚴密監控。當腎分膿瘍的培養結果顯示混合菌叢時，應該要考應有瘻管形成。進一步的放射線檢查，包括瘻管攝影，被高度建議使用。合併適度的引流、抗生素以及結腸吻合術共同治療，對於腎旁膿瘍併發腎旁結腸瘻管的病人而言，是一種好的治療選擇。
關鍵字
無資料並列摘要
Perirenal hematoma complicated with perirenal abscess is not common. Furthermore, a perirenocolonic fistula is a rare sequela of perirenal abscesses. We report a 73-year-old woman presented with one-month indolently left flank soreness and then diagnosed as a life-threatening perirenocolonic fistula. Perirenal material aspirated under ultrasound guiding reveals purulent. The culture grew Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus, Bacteroides fragilis, Peptostreptococcus, and Candida albicans. A fistula between perirenal space and gastrointestinal tract was thus suspected. Computed tomography of the abdomen and lower gastrointestinal study with barium enema were arranged and showed fistulous tract between the descending colon near the splenic flexure and the left perirenal space. After treatment with debridement, antibiotics, colonostomy, and adequate drainage, the patient had being gradually recovery. The symptom and laboratory data in a perirenal abscess are nonspecific usually so that a perirenal hematoma should be closely monitored. When the culture of a perirenal abscess revealed mixed microorganisms, fistulous formation should be considered. Further survey by radiological study including fistulography is highly suggested. Combination treatment of adequate drainage, antibiotics, and colonostomy is a good choice for perirenal abscess complicated with perirenocolonic fistula.
延伸閱讀
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