單一巨大輸尿管息肉引起輸尿管套疊:病例報告與文獻探討
陳柏華、陳俊吉、王百孚、林介山、江恆杰、嚴孟意
張進寶、黃勝賢、黃國軒、石宏仁、張建祥、陳建廷
彰化基督教醫院 外科部 泌尿科
Single massive ureter polyp causing ureter intussusception: a case report and literature review
Pao-Hwa Chen, Chun-Chi Chen, Bai-Fu Wang, Jesen Lin, Heng-Chieh Chiang, Meng-Yi Yan, Chang-Pao Chang, Sheng-Hsien Huang, Kuo-Hsuan Huang, Hung-Jen Shih, Jian-Xiang Zhang, Jian-ting Chen
Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
Introduction:
Ureteral intussusception is a rare complication caused by intra-ureteral lesions (i.e. ureteral calculi or ureteral mass). Here, we present a case of ureteral intussusception cause by single massive ureteral polyp.
Case presentation:
This 44 years old man first presented at our ER symptoms of renal colicky pain and painless gross hematuria. After initial survey, IVP showed middle ureteral stricture without distal ureter enhancement. Due to symptoms of painless gross hematuria, cystoscopy and ureteroscopy was ordered. Intra-operative images showed huge polyp at lower 1/3 ureter and uretero-vesical junction. Biopsy was obtained and obstruction was relieved with electrocautery. Due to size of the polyp, malignancy was first suspected and CT scan was ordered and intussusception of middle ureter was noted. Biopsy later revealed to be fibroepithelial polyp of ureter.
Conclusion and discussion:
Intussusception of ureter is a rare complication of intra-ureteral lesion with the typical presentation of flank colicky pain, hematuria and hydroureter. Most of the prior reported cases of ureteral intussusceptions were benign in origin, but the first case of intussusceptions caused by ureteral TCC was reported on 1987. Ever since, half of the reported cases of intussusceptions are related to intra-ureteral malignancy. Therefore, we also keep malignancy in our minds in cases with images of intussusceptions and the typical symptoms until proven otherwise with biopsy.