輸尿管-血管廔管: 一個克隆氏腸炎病人之個案報告
林巧文1 林子平12 黃志賢12
1台北榮民總醫院泌尿部
2國立陽明交通大學醫學院泌尿學科及書田泌尿科學研究中心
Inflammatory Bowel Disease Related Vascular-Ureter Fistula: A case report
Chyau-Wen Lin1, Tzu-Ping Lin12, William JS Huang12
1Department of Urology, Taipei Veterans General Hospital, Taiwan
2Department of Urology, College of Medicine and Shu-Tien Urological Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
This 41-year-old man with history of Crohn's disease under immunosuppressants use.
According to the patient’s statement, he underwent bilateral ureterorenoscopic lithotripsy due to bilateral ureter stone in 2018/08 at outside hospital. According to the medical records, diffuse calcification was noted along the left ureter. DJ stents were inserted at the end of the procedure. However, repeated blood clot tamponade occurred within months, and abdominal CT in 2019/02 revealed focal abscess formation at presacral space extending to right
ischiorectal fossa, with a fistula communication with the sigmoid colon. Some blood clots were also noted in left collecting system. Cystoscopy revealed oozing from left UO with bilateral DJ in proper position. Due to recurrent blood clot tamponade, he thus came to our Urology out-patient department for help. Left diagnostic URS was performed on 2019/05/10, but middle third ureteral stricture was noted, with massive bleeding from left ureteral orifice (UO) after ureteroscope withdrawal and DJ placement. The bleeders stopped spontaneously afterwards, and the second trial of diagnostic URS was performed five days later. Recurrent massive bleeding was noted from left UO again while we pulled out the pre-existing DJ. This time, due to persistent bleeding, CT angiography was arranged, which revealed one fistula between left iliac artery and left lower ureter. After discussion with radiologists, coil embolization was performed at the lesion mentioned above. After embolization, there was no blood clot tamponades noted.