Mizumura Naoto, Imagawa Atsuo, Kawasaki Masayasu, Okumura Satoshi, Toyoda Sho, Ogawa Masao
Department of Surgery Bellland General Hospital Sakai Osaka Japan.
Acute Med Surg. 2015 Aug 12;3(2):152-154. doi: 10.1002/ams2.150. eCollection 2016 Apr.
An 88-year-old woman presented with abdominal pain, massive ascites, and acute kidney injury. She was clinically hypervolemic and the computed tomography attenuation value of the ascites was near that of water. Subsequent abdominocentesis revealed ammonia-smelling ascites fluid, leading to a suspicion of urinary tract injury, and a conclusive diagnosis of spontaneous bladder rupture was achieved using cystography.
The patient was managed conservatively with antibiotics, percutaneous drainage, and bladder catheter. As a result, she was discharged with normal renal function.
The diagnosis of bladder rupture is difficult, and is rarely confirmed in the absence of a diagnostic suspicion. This case indicates that ascitic fluid odor, patient volume status, and the computed tomography attenuation value of ascites are potential indicators of bladder rupture.
一名88岁女性出现腹痛、大量腹水和急性肾损伤。临床上她处于血容量过多状态，腹水的计算机断层扫描衰减值接近水的衰减值。随后的腹腔穿刺术显示腹水有氨味，这引发了对尿路损伤的怀疑，通过膀胱造影术最终确诊为自发性膀胱破裂。
患者接受了抗生素、经皮引流和膀胱导管的保守治疗。结果，她出院时肾功能正常。
膀胱破裂的诊断困难，在没有诊断怀疑的情况下很少能得到确诊。该病例表明腹水气味、患者容量状态以及腹水的计算机断层扫描衰减值是膀胱破裂的潜在指标。
