Prasetiyanti Rinta, Robi'ul Fuadi Muhamad, Azmi Yufi Aulia, Wirjopranoto Soetojo
Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Department of Urology, Faculty of Medicine Universitas Airlangga, Universitas Airlangga Academic Hospital, Surabaya, Indonesia; Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Int J Surg Case Rep. 2024 May;118:109638. doi: 10.1016/j.ijscr.2024.109638. Epub 2024 Apr 20.
Postoperative peritoneal infection, a common complication, remains prevalent despite surgical advancements. Acute abdomen necessitates rapid treatment, often presenting with abdominal pain and systemic inflammation. Bladder injuries, potentially leading to sepsis, require immediate surgical intervention.
We report a case of a 60-year-old man who came with the main complaint of feeling full in his stomach for 7 days, accompanied by non-radiating right lower abdominal pain since one day before hospital admission and a lethargy condition. There are complaints of seepage from the stitch marks on the right stomach, such as yellow urine. Laboratory and physical examination showed the patient in sepsis condition. CT Cystography showed a defect of 0.4 cm on the bladder dome, the contrast leakage into extraperitoneal and intraperitoneal, and tunneling to the right abdominal subcutaneous. The patient underwent subcutaneous abscess, bladder repair, and cystostomy. One month after surgery, the patient had normal micturition.
Acute abdominal pain is one sign of emergency surgery. It can be caused by infection, inflammation, vascular occlusion, or obstruction. Physical and laboratory examination of the patient showed a sepsis condition. CT Cystography showed the presence of bladder rupture and subcutaneous abscess. The only management is surgical exploration for infection source control.
This case underscores the importance of prompt diagnosis and comprehensive management, involving surgical intervention and targeted antibiotics, for sepsis-related complications post-TURP and bladder repair, necessitating a multidisciplinary approach for optimal outcomes and complication prevention.
术后腹膜感染是一种常见并发症，尽管手术技术不断进步，但仍然普遍存在。急腹症需要迅速治疗，通常表现为腹痛和全身炎症。膀胱损伤可能导致败血症，需要立即进行手术干预。
我们报告一例60岁男性患者，主要主诉为胃部饱胀感7天，自入院前一天起伴有右下腹非放射性疼痛及嗜睡状态。患者主诉右腹部缝线处有渗漏，如黄色尿液样。实验室检查和体格检查显示患者处于败血症状态。CT膀胱造影显示膀胱顶部有0.4厘米的缺损，造影剂渗漏至腹膜外和腹腔内，并向右侧腹部皮下蔓延。患者接受了皮下脓肿切开引流、膀胱修补术和膀胱造瘘术。术后一个月，患者排尿正常。
急性腹痛是急诊手术的一个体征。它可能由感染、炎症、血管阻塞或梗阻引起。对该患者的体格检查和实验室检查显示其处于败血症状态。CT膀胱造影显示存在膀胱破裂和皮下脓肿。唯一的处理方法是进行手术探查以控制感染源。
该病例强调了对于经尿道前列腺电切术（TURP）和膀胱修复术后与败血症相关并发症进行及时诊断和综合管理的重要性，这需要多学科方法以实现最佳治疗效果并预防并发症，其中包括手术干预和针对性使用抗生素。
