Hayashi Waka, Nishino Tomoya, Namie Satoru, Obata Yoko, Furukawa Masataka, Kohno Shigeru
Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan.
J Med Case Rep. 2014 Feb 12;8:46. doi: 10.1186/1752-1947-8-46.
Spontaneous bladder rupture is an extremely rare clinical event that is associated with urinary ascites and apparent acute renal failure. This event is difficult to diagnose clinically, even with advanced techniques such as computed tomography; however, the timely diagnosis of this condition is critical. Here, we report a case of a patient who experienced a spontaneous intraperitoneal bladder rupture 10 years after postoperative pelvic irradiation for the treatment of uterine cancer. In this report of a rare case, we describe the contribution of the appearance of mesothelial cells in the urine to the diagnosis of this condition.
Our patient was a 71-year-old Asian woman who experienced lower abdominal pain and vomiting of two days duration. On admission, abdominal computed tomography showed intraperitoneal fluid collection and her blood tests revealed acute renal failure and hyperkalemia. She underwent hemodialysis and a transurethral catheter was inserted. The transurethral catheter was removed three days after her admission. Four days after the catheter removal, her symptoms recurred and her serum creatinine and blood urea nitrogen levels were elevated. We noted the presence of mesothelial cells in her urine, which led to a diagnosis of intraperitoneal bladder rupture. She underwent surgical repair of her bladder and hyperbaric oxygen therapy, and was discharged after her renal function returned to normal.
Urine analysis is a simple and non-invasive test and we believe that a thorough urine analysis may contribute to the early diagnosis of an intraperitoneal bladder rupture. We think that the findings presented in this case report will significantly enhance our understanding of the etiology of bladder rupture. Moreover, these case findings may help nephrologists and urologists to rapidly diagnose this condition.
自发性膀胱破裂是一种极为罕见的临床事件，与尿腹水和明显的急性肾衰竭相关。即使采用计算机断层扫描等先进技术，这种情况在临床上也难以诊断；然而，及时诊断这种病症至关重要。在此，我们报告一例患者，该患者在因子宫癌接受盆腔放疗术后10年发生了自发性腹膜内膀胱破裂。在这份罕见病例报告中，我们描述了尿液中出现间皮细胞对该病症诊断的作用。
我们的患者是一名71岁的亚洲女性，出现持续两天的下腹痛和呕吐症状。入院时，腹部计算机断层扫描显示腹腔内有积液，血液检查显示急性肾衰竭和高钾血症。她接受了血液透析，并插入了经尿道导管。入院三天后拔除了经尿道导管。导管拔除四天后，她的症状复发，血清肌酐和血尿素氮水平升高。我们注意到她的尿液中存在间皮细胞，这导致诊断为腹膜内膀胱破裂。她接受了膀胱手术修复和高压氧治疗，肾功能恢复正常后出院。
尿液分析是一种简单且无创的检查，我们认为全面的尿液分析可能有助于腹膜内膀胱破裂的早期诊断。我们认为本病例报告中的发现将显著增进我们对膀胱破裂病因的理解。此外，这些病例发现可能有助于肾内科医生和泌尿外科医生快速诊断这种病症。
