Watanabe Yusuke, Yamazaki Shun, Yokoyama Hanako, Yakubo Shunta, Osaki Akihiko, Takaku Kenichi, Sato Munehiro, Waguri Nobuo, Terai Shuji
Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata 950-1141, Japan.
Division of Preemptive Medicine for Digestive Disease and Healthy Active Life, School of Medicine, Niigata University, Niigata 951-8510, Japan.
Medicines (Basel). 2021 Nov 5;8(11):67. doi: 10.3390/medicines8110067.
Since generalized peritonitis is a fatal disease, accurate diagnosis and treatment are important. In this paper, we report a case of recurrent generalized peritonitis associated with spontaneous urinary bladder rupture (SBR). A 65 year old woman, who underwent radiotherapy 21 years prior, was diagnosed with generalized peritonitis. Although the cause of the generalized peritonitis could not be identified, the patient recovered with conservative treatment in short period. However, recurrent episodes of generalized peritonitis occurred four times. We diagnosed the patient with urinary ascites due to SBR, based on a history of radiotherapy and dysuria. No recurrence of generalized peritonitis had occurred after accurate diagnosis and treatment with long-term bladder catheter placement. Since SBR often occurs as a late complication after radiotherapy, it is difficult to diagnose SBR, which leads to delayed treatment. This case and literature review of similar cases suggest that the information of the following might be helpful in the diagnosis of SBR: (i) history of recurrent generalized peritonitis, (ii) pseudo-renal failure, (iii) history of radiotherapy, (iv) dysuria, and (v) increase or decrease of ascites in a short period. It is important to list SBR in the differential diagnosis by knowing the disease and understanding its clinical features. This case and literature review will serve as a reference for future practices.
由于弥漫性腹膜炎是一种致命疾病，准确的诊断和治疗至关重要。在本文中，我们报告了一例与自发性膀胱破裂（SBR）相关的复发性弥漫性腹膜炎病例。一名65岁女性，21年前接受过放疗，被诊断为弥漫性腹膜炎。尽管弥漫性腹膜炎的病因无法确定，但患者经保守治疗在短期内康复。然而，弥漫性腹膜炎反复发作了四次。基于放疗史和排尿困难，我们诊断该患者为SBR所致的尿腹水。经过准确诊断并长期留置膀胱导管治疗后，弥漫性腹膜炎未再复发。由于SBR常作为放疗后的晚期并发症出现，因此难以诊断，导致治疗延误。该病例及类似病例的文献综述表明，以下信息可能有助于SBR的诊断：（i）复发性弥漫性腹膜炎病史；（ii）假性肾衰竭；（iii）放疗史；（iv）排尿困难；（v）短期内腹水的增减。通过了解该疾病并理解其临床特征，将SBR列入鉴别诊断很重要。该病例及文献综述将为未来的实践提供参考。
