Yanagawa Youichi, Murai Yuta, Kushida Yoshihiro, Sakurada Mutsumi
Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, JPN.
Surgery, Shizuoka Hospital, Juntendo University, Izunokuni, JPN.
Cureus. 2021 Apr 16;13(4):e14520. doi: 10.7759/cureus.14520.
An H-section steel bar that had been set against the wall fell and hit the abdomen and then both legs of a 33-year-old Chinese man. As his vital signs were stable and his chief complaint was leg pain, he was transferred to a local medical facility. After the confirmation of gross hematuria by an indwelling a bladder catheter there, he was transported to our hospital. On arrival, his vital signs were stable. His main complaint was foot pain. He had a scabbing injury at the scrotum and bilateral foot joint deformity. Whole-body computed tomography (CT) from head to toe revealed trabecular formation in the bladder and slight fluid collection in the rectovesical pouch, as well as bilateral fracture-dislocations at the ankles. The urinary tract injury and the fluid collection in the rectovesical pouch were managed conservatively, and the lower limbs were treated tentatively. Follow-up CT on day 3 revealed multiple free air pockets in the intra-abdominal cavity, which was considered to indicate perforation of the duodenal ulcer and treated conservatively. However, he showed abdominal pain on day 7, and repeated CT revealed increased fluid in the intra-abdominal cavity. Urgent laparoscopy showed intact bowels and perforation of the bladder that was closed by suturing. He ultimately obtained a survival outcome. This is the first case of transient trabecular formation in the bladder and delayed free air due to traumatic intraperitoneal bladder rupture. This unique case adds another radiological finding to the list of documented etiologies of traumatic bladder perforation.
一根靠在墙上的H型钢倒下，砸中了一名33岁中国男子的腹部，随后又砸到了他的双腿。由于其生命体征稳定，主要诉求是腿部疼痛，他被转至当地医疗机构。在那里通过留置膀胱导管确认有肉眼血尿后，他被转送至我院。入院时，他的生命体征稳定。主要诉求是足部疼痛。他阴囊处有结痂损伤，双侧足部关节畸形。从头到脚的全身计算机断层扫描（CT）显示膀胱内有小梁形成，直肠膀胱陷凹有少量积液，以及双侧踝关节骨折脱位。尿路损伤和直肠膀胱陷凹积液采取保守治疗，下肢进行了初步处理。第3天的随访CT显示腹腔内有多个游离气腔，考虑提示十二指肠溃疡穿孔并进行了保守治疗。然而，他在第7天出现腹痛，复查CT显示腹腔内积液增多。紧急腹腔镜检查显示肠道完好，膀胱穿孔，通过缝合进行了闭合。他最终获得了生存结局。这是首例因外伤性腹膜内膀胱破裂导致膀胱短暂小梁形成和延迟出现游离气的病例。这一独特病例为外伤性膀胱穿孔的已记录病因清单增添了另一项影像学表现。
