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膀胱憩室自发性破裂伴假性肾衰竭:一例报告及文献复习

Spontaneous rupture of bladder diverticulum with pseudo renal failure:A case report and literature review.

作者信息

Zhang Zhuo, Shen Jing, He Qian, Nie Hu

机构信息

Department of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.

Department of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Xiamen Hospital of Sichuan University, Xiamen, Fujian, China.

出版信息

Am J Emerg Med. 2024 May;79:231.e3-231.e7. doi: 10.1016/j.ajem.2024.03.011. Epub 2024 Mar 16.

Abstract

BACKGROUND

Spontaneous or non-traumatic bladder rupture is rare but can be life-threatening. Bladder rupture caused by a diverticulum is extremely rare, with only a few case reports in medical literature.

CASE PRESENTATION

We report the case of a 32-year-old woman admitted to hospital complaints of abdominal pain, oliguria and ascites with no history of trauma. Laboratory tests revealed an elevated serum urea nitrogen(UN) level of 33.5 mmol/l and an elevated creatinine levels of 528 umol/l. X-ray cystography confirmed the rupture of a bladder diverticulum. Subsequent transurethral catheterization led to a prompt increase in urinary output, and serum creatinine level returned to 40 umol/l within 48 h. The patient was successfully treated with laparoscopic diverticulectomy.

CONCLUSION

Clinicians should maintain a high level of suspicion for urinary bladder rupture in cases presenting with acute lower abdominal pain, urinary difficulties, and oliguria. When acute renal failure, complicated ascites, and an elevated peritoneal fluid creatinine or potassium level exceeding serum levels are observed, intraperitoneal urine leakage should be suspected without delay. This case emphasizes the importance of early diagnosis and intervention in managing this rare but serious condition.

摘要

背景

自发性或非创伤性膀胱破裂较为罕见,但可能危及生命。由膀胱憩室引起的膀胱破裂极为罕见,医学文献中仅有少数病例报告。

病例介绍

我们报告一例32岁女性患者,因腹痛、少尿和腹水入院,无创伤史。实验室检查显示血清尿素氮(UN)水平升高至33.5 mmol/l,肌酐水平升高至528 μmol/l。膀胱造影证实膀胱憩室破裂。随后经尿道插管使尿量迅速增加,血清肌酐水平在48小时内恢复至40 μmol/l。患者通过腹腔镜憩室切除术成功治愈。

结论

对于出现急性下腹痛、排尿困难和少尿的病例,临床医生应高度怀疑膀胱破裂。当观察到急性肾衰竭、并发腹水以及腹腔积液肌酐或钾水平超过血清水平时,应立即怀疑腹腔内尿液漏出。本病例强调了早期诊断和干预对于处理这种罕见但严重疾病的重要性。

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