Hardy Adam Joseph, Stoica Ionica, Kearney David Edward, O'Riordain Diarmuid S
Department of Paediatric Surgery, Our Lady's Children's Hospital, Dublin, Ireland
Department of General & Vascular Surgery, Tallaght Hospital, Dublin, Ireland.
BMJ Case Rep. 2020 Apr 16;13(4):e228818. doi: 10.1136/bcr-2018-228818.
A 62-year-old man presented to our institute with diarrhoea and dysuria on a background of subtotal colectomy and end ileostomy and biological therapy for Crohn's disease. He was diagnosed with urinary tract infection and acute kidney injury (AKI). Renal ultrasound suggested left hydronephrosis, with renal protocol computed tomography (CT) showing a large pelvic mass. Magnetic resonance imaging (MRI) of the pelvis demonstrated a rectal tumour invading the bladder and compressing both ureters. He underwent cystoscopy, flexible sigmoidoscopy and positron emission tomography-CT and was diagnosed with stage IV non-Hodgkin's diffuse large B-cell lymphoma. He was treated primarily with rituximab, cyclophosphamide, hydroxydaunomycin, oncovin and prednisolone chemotherapy regimen. He had ongoing urosepsis before admission for pelvic exenteration. He underwent cystoprostatectomy, excision of rectal stump and formation of ileal conduit. Histology showed no signs of residual malignancy. One year later, the patient was admitted to the intensive care unit with aspiration pneumonia, urosepsis and AKI. Despite maximal therapy, he developed multiorgan failure and passed away.
一名62岁男性因克罗恩病接受了结肠次全切除术及末端回肠造口术和生物治疗，之后因腹泻和排尿困难前来我院就诊。他被诊断为尿路感染和急性肾损伤（AKI）。肾脏超声提示左肾积水，肾脏增强计算机断层扫描（CT）显示盆腔有一个大肿块。盆腔磁共振成像（MRI）显示直肠肿瘤侵犯膀胱并压迫双侧输尿管。他接受了膀胱镜检查、乙状结肠镜检查和正电子发射断层扫描-CT检查，被诊断为IV期非霍奇金弥漫性大B细胞淋巴瘤。他主要接受了利妥昔单抗、环磷酰胺、羟基柔红霉素、长春新碱和泼尼松龙化疗方案的治疗。在因盆腔脏器清除术入院前，他一直存在尿脓毒症。他接受了膀胱前列腺切除术、直肠残端切除术和回肠造瘘术。组织学检查未发现残留恶性肿瘤的迹象。一年后，该患者因吸入性肺炎、尿脓毒症和AKI入住重症监护病房。尽管进行了最大程度的治疗，他仍出现多器官功能衰竭并去世。
