Inoguchi Kyosuke, Hongo Takashi, Naito Hiromichi, Nakao Atsunori
Emergency Department, Okayama Saiseikai General Hospital, Okayama, JPN.
Emergency, Critical Care, and Disaster, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN.
Cureus. 2021 Oct 19;13(10):e18913. doi: 10.7759/cureus.18913. eCollection 2021 Oct.
Spontaneous bladder rupture is an uncommon and life-threatening urological emergency, and early diagnosis is often challenging. Herein, we report a case of intraperitoneal bladder rupture in an 81-year-old male with neurogenic bladder-the case of intraperitoneal bladder rupture required late laparotomy for pelvic abscess following initial conservative treatment. An eighty-one-year-old male presented to our emergency department with deterioration of consciousness, fever, and hematuria. He denied previous trauma history and had been treated for neurogenic bladder. Physical examination revealed signs of tenderness in the abdomen. A diagnosis of bladder rupture was made based on laboratory examination indicating renal failure and radiological imaging showing urinary ascites. Conservative management with a Foley catheter and antibiotics (meropenem administered 1 g/day) was initiated. On day seven after admission, the patient complained of abdominal pain and fever, and a diagnosis of pelvic abscess based on contrast-enhanced computed tomography and septic peritonitis was made. An emergency exploratory laparotomy for peritoneal drainage was performed. The postoperative course was uneventful, and the patient was discharged on day 29 after admission. Urinary bladder rupture should always be considered as a differential diagnosis in patients presenting with free fluid in the abdomen, peritonitis, reduced urine output, and hematuria. Clinicians should be aware that secondary bacterial peritonitis can occur as a major complication of a ruptured urinary bladder.
自发性膀胱破裂是一种罕见且危及生命的泌尿外科急症，早期诊断往往具有挑战性。在此，我们报告一例81岁患有神经源性膀胱的男性患者发生腹膜内膀胱破裂的病例——该腹膜内膀胱破裂病例在初始保守治疗后因盆腔脓肿需要延迟剖腹手术。一名81岁男性因意识恶化、发热和血尿就诊于我院急诊科。他否认既往有外伤史，且一直患有神经源性膀胱。体格检查发现腹部有压痛体征。基于提示肾衰竭的实验室检查及显示尿腹水的影像学检查结果，诊断为膀胱破裂。开始采用Foley导管及抗生素（美罗培南1 g/天）进行保守治疗。入院后第7天，患者诉腹痛和发热，基于增强计算机断层扫描及感染性腹膜炎诊断为盆腔脓肿。进行了急诊剖腹探查术以行腹膜引流。术后过程顺利，患者于入院后第29天出院。对于出现腹腔内游离液体、腹膜炎、尿量减少及血尿的患者，应始终将膀胱破裂视为鉴别诊断之一。临床医生应意识到继发性细菌性腹膜炎可能作为膀胱破裂的主要并发症发生。
