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阑尾炎引起右输尿管下段梗阻比较少见,我院收治2例。例1 男,23岁。右侧腰部胀痛20天。20天前因“急性阑尾炎”在外院保守治疗。体检:体温正常,右上腹有深压痛,无反跳痛。B超及排泄性尿路造影(IVP)检查均示右肾中度积水,右输尿管中、上段扩张积水,下段显示不清。膀胱镜检查:右输尿管口无喷尿,逆行插管3cm受阻。行右侧腰腹部手术探查,发现右输尿管中、上段扩张积水,下段输尿管连同后腹膜及髂血管一起被炎性纤维组织严重粘连成包块,分离十分困难。由梗阻上端将输尿管切一小口,向下置入输尿管导管未能通过。打开侧腹膜发现阑尾已腐蚀殆尽,处理好阑尾残端,测量输尿管梗阻段长约5cm,行膀胱壁瓣输尿管吻合术。术后恢复顺利,3个月后复查IVP未见异常.膀胱造影未见输尿管返流。
Appendicitis caused by lower right ureter obstruction is relatively rare, 2 cases admitted to our hospital. Example 1 male, 23 years old. The right side of the waist pain for 20 days. 20 days ago due to “acute appendicitis” conservative treatment in the hospital. Physical examination: normal body temperature, right upper quadrant deep tenderness, no rebound tenderness. B ultrasound and urinary excretion urography (IVP) examination showed moderate hydronephrosis, right ureter, the upper part of the expansion of water, the next paragraph is not clear. Cystoscopy: right ureteral orifice without squirting, retrograde intubation 3cm blocked. Line right waist and abdominal surgery exploration and found that the right ureter, the upper segment of the expansion of water, the lower ureter with retroperitoneal and iliac vessels together with inflammatory fiber tissue severe adhesions into mass, the separation is very difficult. From the upper obstruction ureter cut a small mouth, down into the ureteral catheter failed to pass. Open the side of the peritoneum found that the appendix has been corroded, deal with the appendix stump, measure the length of the ureteral obstruction about 5cm, line bladder flap ureter anastomosis. Postoperative recovery was successful, and no abnormal IVP was observed after 3 months. No urinary reflux was found in cystography.