慢性消化性潰瘍穿孔暨十二指腸輸尿管廔管病例討論

李毅彥、許兆畬、童敏哲、殷約翰、戴浩平、謝肇新、陳祥來

童綜合醫院 外科部 泌尿科

A case of total right upper ureter occlusion due to chronic peforation peptic ulcer with duodeno-ureteral fistula formation

I-Yen Lee, Chao-Yu Hsu, Min-Che Tung, Jue-Hawn Yin

, Hao-Ping Tai, Siu-San Tse, Hsiang-Lai Chen

Divisions of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan

Abstract:

A 50 year-old man with a diagnosis of large duodenal ulcer with fistula formation, seal-off perforation and retroperitoneal abscess with involved to right upper ureter. Right flank pain and abdominal pain was noted for about 1 year. Labrotory data revealed anemia Upper GI panendoscopy revealed a large ulcer with central necrosis debris at posterior wall of the bulb of duodenum. UGI and small bowel series revealed duodenal leakage to right retroperitoneal space and right PUJ and upper ureter were involved. Right upper ureter total occlusion and right hydronephrosis was noted after kidney sonography, right ureterorenoscopy and right retrograde pyelography. Right PCND was done for urine diversion. Tc-99m DTPA renography revealed GFR: left 80% and right 20%. In addition, PTCD for retropeitoneal abscess drainage was performed. After urine diversion ,retreoperitoneal abscess drainage and PPI treatment for two months, duodenal fistula to upper ureter was still noted.

He was close follow up at GS and Urological OPD, Right flank pain was improved but duodeno-ureter fistula was still noted. Recently, right antegrade pyelography revealed right UPJ extravsation. Right nephrectomy and duodenal fistula excision was advise.