Bartholomew Reid, Ahmeti Mentor
Department of Surgery, University of North Dakota, Grand Forks, ND 58202, USA.
Trauma and Acute Care Surgery, Sanford Medical Center, Fargo, ND 58104, USA.
Case Rep Surg. 2021 Aug 30;2021:6615817. doi: 10.1155/2021/6615817. eCollection 2021.
A female patient presented four years following spontaneous bladder rupture with a recurrent spontaneous bladder rupture. . Urinary bladder rupture is a condition usually caused by trauma or surgical instrumentation. Spontaneous bladder rupture is a much more uncommon condition and is associated with intoxication, radiation, stricture, or neurogenic bladder. We describe a case of a 40-year-old woman with a history of three caesarian sections with an idiopathic recurrent spontaneous bladder rupture. Originally, she presented with one day of worsening severe abdominal pain. CT showed possible ischemic bowel. She was taken to the operating room (OR) and found to have a bladder rupture. This was repaired, and she did well postoperatively. Four years later, she presented to the emergency department (ED) with one week of worsening abdominal pain that became severe acutely. Given that she had a similar issue four years prior the patient was suspicious, her bladder was again ruptured. CT cystogram showed contrast extravasation into the peritoneum. The patient was taken urgently to the operating room for an open repair of the bladder rupture. She did well following the procedure.
Spontaneous bladder rupture is a surgical emergency and should be in the differential diagnosis of any patient with peritonitis with elevated creatinine and free intraperitoneal fluid. This diagnosis should especially be considered if the patient has a history pelvic radiation, neurogenic bladder, or intoxication. We submit that a history of multiple pelvic surgeries should be included in this list. CT cystogram is the diagnostic test of choice. Operative repair is generally the treatment for this condition.
一名女性患者在自发性膀胱破裂四年后出现复发性自发性膀胱破裂。膀胱破裂通常由创伤或手术器械引起。自发性膀胱破裂是一种更为罕见的情况，与中毒、辐射、狭窄或神经源性膀胱有关。我们描述了一例40岁女性病例，她有三次剖宫产史，患有特发性复发性自发性膀胱破裂。最初，她因严重腹痛加重一天前来就诊。CT显示可能存在缺血性肠病。她被送往手术室，发现有膀胱破裂。进行了修复，术后恢复良好。四年后，她因腹痛加重一周且急性加重而到急诊科就诊。鉴于她四年前有过类似情况，患者对此表示怀疑，其膀胱再次破裂。CT膀胱造影显示造影剂外渗至腹膜。患者被紧急送往手术室进行膀胱破裂的开放修复。术后恢复良好。
自发性膀胱破裂是一种外科急症，应列入任何伴有肌酐升高和腹腔内游离液体的腹膜炎患者的鉴别诊断中。如果患者有盆腔放疗、神经源性膀胱或中毒史，尤其应考虑这一诊断。我们认为，这一清单中应包括多次盆腔手术史。CT膀胱造影是首选的诊断检查。手术修复通常是这种情况的治疗方法。
