Merga Osias Tilahun, Bayileyegn Nebiyou Simegnew
Department of Surgery, Jimma University Medical Center, Jimma, Ethiopia.
Department of Surgery, Jimma University Medical Center, Jimma, Ethiopia.
Int J Surg Case Rep. 2023 Oct;111:108942. doi: 10.1016/j.ijscr.2023.108942. Epub 2023 Oct 10.
Bladder rupture, or perforation, is the rupture of the urinary bladder, which is often clinically classified as intraperitoneal, extraperitoneal, or combined types. Spontaneous bladder perforation is an extremely rare event and constitutes less than 2 % of bladder ruptures. It is often associated with previous bladder manipulation, lower urinary tract obstruction, instrumentation, pelvic radiotherapy or surgery, inflammation, and malignancy. Blood work will demonstrate leukocytosis with left shift, hematuria on urinalysis, and an ascites to serum creatinine ratio of more than one, which is highly suggestive of bladder rupture.
A 38-year-old male patient presented with abdominal pain for 8 h and loss of consciousness lasting 4 h. The patient was acutely sick-looking with borderline blood pressure of 90/60 mmHg, pulse rate of 120, and has alcoholic breath. With a diagnosis of viscus perforation, he was operated and there was a 1 × 1 cm bladder dome perforation, which looks fresh. The ruptured edge was refreshed and repaired in two layers. The patient has recovered well, discharged and was fine on subsequent follow-ups.
Bladder rupture commonly develops after blunt abdominal trauma, of which more than 60 % is extraperitoneal. Intraperitoneal bladder rupture constitutes only a small fraction of all cases of rupture. There are only a few reports of spontaneous bladder rupture in the scientific literature. The risk of bladder rupture may be increased in the alcohol-impaired patient owing to decreased bladder filling sensation and abnormal behavioral responses.
Bladder rupture is a rare diagnosis in surgical patients, and spontaneous rupture is by far a very rare finding. The diagnosis of bladder perforation is often overlooked preoperatively for the obvious reason of its rarity and non-specific presentation. Early identification and timely management decrease mortality.
膀胱破裂，即膀胱穿孔，是指膀胱的破裂，临床上通常分为腹膜内型、腹膜外型或混合型。自发性膀胱穿孔是一种极其罕见的情况，占膀胱破裂病例的比例不到2%。它常与先前的膀胱操作、下尿路梗阻、器械检查、盆腔放疗或手术、炎症及恶性肿瘤相关。血液检查会显示白细胞增多伴核左移，尿液分析有血尿，腹水与血清肌酐比值大于1，这高度提示膀胱破裂。
一名38岁男性患者因腹痛8小时、意识丧失4小时前来就诊。患者急性病容，血压临界值为90/60 mmHg，脉搏率120次/分，有酒精气味。诊断为脏器穿孔后，患者接受了手术，发现膀胱顶部有一个1×1厘米的穿孔，看起来很新鲜。对破裂边缘进行了修整并分两层进行修复。患者恢复良好，已出院，后续随访情况良好。
膀胱破裂通常在腹部钝性创伤后发生，其中超过60%为腹膜外型。腹膜内膀胱破裂仅占所有破裂病例的一小部分。科学文献中关于自发性膀胱破裂的报道很少。酒精影响的患者由于膀胱充盈感觉减退和行为反应异常，膀胱破裂的风险可能会增加。
膀胱破裂在外科患者中是一种罕见的诊断，而自发性破裂更是极为罕见的发现。由于其罕见性和非特异性表现，膀胱穿孔的诊断在术前常被忽视。早期识别和及时处理可降低死亡率。
