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经皮腹膜透析置管术后膀胱穿孔损伤:一例报告。

Bladder perforation injury after percutaneous peritoneal dialysis catheterization: A case report.

作者信息

Shi Chun-Xia, Li Zhong-Xin, Sun Hai-Tao, Sun Wu-Qing, Ji Yu, Jia Shu-Jing

机构信息

Department of Nephrology, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing 101149, China.

Department of General Surgery, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing 101149, China.

出版信息

World J Clin Cases. 2022 Jul 16;10(20):7054-7059. doi: 10.12998/wjcc.v10.i20.7054.

Abstract

BACKGROUND

Insertion of a catheter into the bladder is a rare complication of peritoneal dialysis (PD), and is mainly related to surgical injury. This paper reports a case of bladder perforation that was caused by percutaneous PD catheterization.

CASE SUMMARY

A 64-year-old man underwent percutaneous PD catheterization for end-stage renal disease. On the second day after the operation, urgent urination and gross hematuria occurred. Urinalysis showed the presence of red and white blood cells. Empirical anti-infective treatment was given. On the third day after the operation, urgent urination occurred during PD perfusion. Ultrasound showed that the PD catheter was located in the bladder, and subsequent computed tomography (CT) showed that the PD catheter moved through the anterior wall into the bladder. The PD catheter was withdrawn from the bladder and catheterization was retained. Repeat CT on the fourth day after the operation showed that the PD catheter was removed from the bladder, but there was poor catheter function. The PD catheter was removed and the patient was changed to hemodialysis. CT cystography showed that the bladder healed well and the patient was discharged 14 d after the operation.

CONCLUSION

Bladder perforation injury should be considered and treated timeously in case of bladder irritation during and after percutaneous PD catheterization. The use of Doppler ultrasound and other related technologies may reduce the incidence of such complications.

摘要

背景

膀胱内插入导管是腹膜透析(PD)的一种罕见并发症,主要与手术损伤有关。本文报告1例经皮腹膜透析置管术致膀胱穿孔的病例。

病例摘要

一名64岁男性因终末期肾病接受经皮腹膜透析置管术。术后第2天,患者出现尿急和肉眼血尿。尿液分析显示存在红细胞和白细胞,给予经验性抗感染治疗。术后第3天,腹膜透析灌注时出现尿急。超声显示腹膜透析导管位于膀胱内,随后的计算机断层扫描(CT)显示腹膜透析导管经前壁进入膀胱。将腹膜透析导管从膀胱中拔出并保留导尿。术后第4天复查CT显示腹膜透析导管已从膀胱中取出,但导管功能不佳。遂拔除腹膜透析导管,患者改为血液透析。膀胱造影CT显示膀胱愈合良好,患者术后14天出院。

结论

经皮腹膜透析置管术期间及术后若出现膀胱刺激症状,应考虑膀胱穿孔损伤并及时处理。使用多普勒超声等相关技术可能会降低此类并发症的发生率。

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