克隆氏症合併長段輸尿管結石引起急性腎損傷及尿液囊腫
李蕎青1,2、江佩璋1、施孟宏1,3、查岱龍1、吳勝堂1、陳進利1
1三軍總醫院外科部泌尿外科；2國軍高雄總醫院外科部；3國軍高雄總醫院左營分院外科部
Crohn’s Disease Complicated with Long-segment Ureteral Stones Causing Acute Kidney Injury and Urinoma Formation
Chiao-Ching, Li1,2、Pei-Jhang, Chiang1、Meng-Hung, Shih1,3、Tai-Lung, Cha1、Sheng-Tang, Wu1、Chin-Li, Chen1
1Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan；
2Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan；
3Department of Surgery, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
Introduction:
Crohn’s disease is a chronic inflammatory bowel disease (IBD) of unknown cause. It can affect gastrointestinal tract from the mouth to the perianal region. The incidence of urolithiasis is higher in patients with IBD than in the general population. We report a rare case of Crohn’s disease associated with long-segment ureteral stones coating on ureteral wall caused several complications.
Case report:
A 40-year-old man, who had medical history of Crohn’s disease, sustained lower abdominal pain for 2 days. He visited our emergency room and no significant abnormal findings revealed by KUB or urinary analysis. Blood analysis showed elevated creatinine level (3.0 mg/dL). Further abdominal CT discovered severe bilateral hydroureteronephrosis, right-sided lower-third ureteral stone, left-sided middle to lower-third ureteral calcification and ureteral rupture with focal retroperitoneal fluid accumulation. Left-sided ureteral urinoma was suspected.
Results:
He underwent left-sided percutaneous nephrostomy (PCN) tube to temporarily drain the urine initially. The creatinine level decreased to 1.2 mg/dL. We performed bilateral ureteroscopy that showed long-segment ureteral stones coating on left-sided ureteral wall and a right-sided lower-third ureteral stone. Laser lithotripsy was done and double-J ureteral stent was placed. After surgery, we removed the PCN tube and the patient was discharged next day.
Conclusion:
Urolithiasis is the most common extraintestinal manifestation in patients of Crohn’s disease. Acute kidney injury, unexplained abdominal pain, urinary tract infection occurred in patients of Crohn’s disease need to be recognized appropriately. We report an unusual case of Crohn’s disease with long-segment ureteral stones coating on ureteral wall rather than nephrolithiasis, which are more common in these patients. These patients need to be followed up appropriately to prevent associated complications such as hydronephrosis, acute renal dysfunction, urinoma formation in our case.