J.Jpn. Surg. Soc.
ISSN 1880-1129

[Abstract] [Full Text PDF] （in Japanese / 886KB） [Members Only And Two Factor Auth.]

J.Jpn. Surg. Soc.. 84(7): 648-653, 1983

Original article

A CASE OF SUDDEN GROSS HEMATURIA CAUSED BY AN ILIAC ARTERY-URETERAL FISTULA

First Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
*) Derartment of Urology, The Jikei University School of Medicine, Tokyo, Japan

Noritake Akaba, Hisashi Ujiie, Kazumasa Umezawa, Kinji Miura, Susumu Kabayashi, Kenji Sakurai, Satoshi Takasaka*)

A 51-year-old male patient, who had been treated for nonspecific angitis with pulselessness in the upper extremities, was found to have stenosis of the left common iliac artery. Patch grafting was performed for the stenotic lesion of the artery. Sixteen months after the operstion, the patient developed a sudden massive hematuria for which he was immediately admitted. He required blood transfusions and bed rest. Pyelography and arteriography revealed almost complete impairment of the left kidney function. During subsequent left retrograde ureterography, the patient again developed massive hematuria and fell in shock.
The ureterogram revealed left hydronephrosis and the adhesive left ureter to the site of the patch graft. Extraluminal outflow of contrast medium into the artery was also noted.
These findings were considered to indicate the hematuria being an extravasation of blood from an arterio-ureteral fistula formed in the patch graft region. An emergency operation was performed.
Contamination was avoided by construction of the femoro-femoral arterial bypass graft to the left lower extremity, prior to the radical removal of the potentially infected fistula and left kidney. The surgical procedures have saved the patient and his lower extremities.

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