Department of Surgery, Kosei General Hospital, 5-25-15 Yayoicho, Nakano-ku, Tokyo 164-8617, Japan.
Surg Today. 2012 Oct;42(10):1005-9. doi: 10.1007/s00595-012-0177-x. Epub 2012 Jun 12.
We herein present a rare case of enterovesical fistula caused by ileal non-Hodgkin's lymphoma. A 75-year-old Japanese male presented with macrohematuria at Kosei General Hospital in December 2010. An egg-sized mass was palpable in his right lower abdominal region, and computed tomography (CT) revealed that the ileal tumor had invaded the right posterior wall of the urinary bladder (UB). A histopathological examination of a CT-guided needle biopsy specimen revealed diffuse large B-cell lymphoma involving the ileum and the UB. Thereafter, fecaluria appeared. A transurethral catheter was put in place, and there were no symptoms of cystitis. The patient received chemotherapy for the lymphoma, which produced a partial response. However, the fecaluria continued, and an examination of the small intestine with contrast revealed a thick and irregular wall of the ileum and a fistula between the ileum and UB. A partial resection of the ileum and a partial cystectomy were carried out in April 2011. The surgical specimen demonstrated two tumors 5 cm apart in the ileum, measuring 4.5 × 7 and 4 × 3 cm in size. The proximal tumor had directly invaded the UB and formed an ileovesical fistula. The patient made a good recovery and was doing well 5 months after the surgery without any evidence of recurrence.
我们在此报告一例由回肠非霍奇金淋巴瘤引起的肠膀胱瘘。一名 75 岁的日本男性于 2010 年 12 月在圣心综合医院出现肉眼血尿。在其右下腹部可触及一个鸡蛋大小的肿块，计算机断层扫描（CT）显示回肠肿瘤已侵犯了膀胱（UB）的右后壁。CT 引导下的经皮针活检组织学检查显示累及回肠和 UB 的弥漫性大 B 细胞淋巴瘤。此后，出现粪便尿。为患者放置了经尿道导尿管，且没有膀胱炎的症状。该患者接受了针对淋巴瘤的化疗，产生了部分缓解。然而，粪便尿持续存在，小肠造影显示回肠的肠壁增厚且不规则，回肠和 UB 之间存在瘘管。2011 年 4 月，进行了回肠部分切除术和部分膀胱切除术。手术标本显示在回肠中相隔 5 厘米有两个肿瘤，大小分别为 4.5×7cm 和 4×3cm。近端肿瘤直接侵犯了 UB 并形成了肠膀胱瘘。患者恢复良好，手术后 5 个月情况良好，没有复发的迹象。
