[症例報告]Renal papillary necrosis : An autopsy case report and a brief review of the literature

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An 83-year-old Japanese woman was admitted to our surgical department for persistent rectal bleeding on July 11, 1997. The patient had received radiotherapy for uterine cervical cancer 3 years previously. Her performance status was grade 3, due to bilateral femoral fracture. Sixteen months after radiotherapy, the patient demonstrated slight rectal bleeding. Since her rectal bleeding was persistent and intractable, she underwent proctectomy with colostomy. The resected rectum histologically showed severe endoarteritis and she was diagnosed to have a radiation proctitis. She developed paralytic bowel obstruction on the 6th post operative day (POD) and renal dysfunction with signs of systemic inflammatory response syndrome on the 10th POD. On the 25th POD, she developed a sudden onset of hematemesis and hypovolemic shock. An emergency endoscopic examination showed bleeding from multiple shallow ulcers in the stomach (acute gastric mucosal lesion). Simultaneously the patient presented with clinical manifestations of sepsis. The patient finally expired due to multiple organ failure. The autopsy revealed clinically insidiously progressing bilateral renal papillary necrosis, which was considered to be the primary cause of her death. Microscopically multiple extensive necrosis areas were observed in the renal papilla.
琉球医学会の論文