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产后伪装成伴有分隔的局限性腹水的自发性膀胱破裂——病例报告

Spontaneous bladder rupture masquerading as loculated ascites with septations in postpartum - A case report.

作者信息

Hansadah Saunri, Balakrishnan Deepthy, Patel Ranjan Kumar, Devi Yangala Sudha, Begum Jasmina

机构信息

Department of OBG, AIIMS, Bhubaneswar, Odisha, India.

Department of Radiodiagnosis, AIIMS, Bhubaneswar, Odisha, India.

出版信息

J Family Med Prim Care. 2024 Nov;13(11):5415-5417. doi: 10.4103/jfmpc.jfmpc_554_24. Epub 2024 Nov 18.

Abstract

The occurrence of spontaneous bladder rupture during labor or the postpartum period after an uncomplicated vaginal delivery is exceedingly uncommon. However, we encountered a case involving spontaneous bladder rupture, which resulted in the development of localized fluid collections in the abdomen after an uncomplicated vaginal delivery. In this instance, the absence of typical peritonitis symptoms, such as abdominal pain or tenderness, and the lack of typical urological symptoms, including haematuria, dysuria, and anuria, coupled with the absence of clinical manifestations of puerperal sepsis, the absence of microbial presence in the ascitic fluid, and the patient's symptomatic amelioration following antibiotic therapy, contributed to a delay in identifying the bladder rupture. The initial management entailed the use of a percutaneous drain, followed by surgical correction of the rupture through laparotomy. This case underscores the necessity of considering intraperitoneal bladder rupture as a plausible diagnosis in cases of enclosed ascitic fluid with multiple partitions following childbirth. Additionally, it prompts considering non-surgical management for substantial intraperitoneal bladder ruptures in asymptomatic patients.

摘要

在无并发症的阴道分娩后的分娩期或产后期发生自发性膀胱破裂极为罕见。然而,我们遇到了一例自发性膀胱破裂病例,该病例在无并发症的阴道分娩后导致腹部出现局限性积液。在此病例中,缺乏典型的腹膜炎症状,如腹痛或压痛,也缺乏典型的泌尿系统症状,包括血尿、排尿困难和无尿,再加上没有产褥期败血症的临床表现,腹水中没有微生物存在,且患者在抗生素治疗后症状有所改善,这些因素导致膀胱破裂的诊断延迟。初始治疗包括使用经皮引流,随后通过剖腹手术对破裂进行手术修复。该病例强调了在产后出现有多个分隔的封闭性腹水病例中,将腹膜内膀胱破裂视为一种合理诊断的必要性。此外,它促使对于无症状患者的大量腹膜内膀胱破裂考虑非手术治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5237/11668444/534b6418f997/JFMPC-13-5415-g001.jpg

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