Rodríguez Rodríguez A, Vendrell R, Luque P, López-Alvarado S, Alcaraz A, Carretero P
Servicio de Urología y Unidad de Trasplante Renal, Hospital Clínico, Universidad de Barcelona.
Actas Urol Esp. 1995 May;19(5):393-7.
Presentation of two clinical cases of spontaneous vesical rupture secondary to bacterial cystitis in elderly patients. One corresponds to an intraperitoneal perforation while the second case was extraperitoneal. The patients were, in both cases, diabetic women admitted in emergency due to acute abdomen. We considered that although vesical perforation secondary to bacterial cystitis is a very uncommon process, it should be taken into account in the differential diagnosis of acute abdomen in predisposed patients (diabetic elderly patients with pyuria). In such instances, a retrograde cystography would provide the diagnosis. Although extraperitoneal vesical perforations can be resolved with a vesical catheter or cystostomy, extravasation of the infected urine may result in a perivesical abscess and septic shock. Early surgical management should be considered in these cases.
老年患者细菌性膀胱炎继发自发性膀胱破裂的两例临床病例报告。一例为腹膜内穿孔，另一例为腹膜外穿孔。两例患者均为糖尿病女性，因急腹症急诊入院。我们认为，尽管细菌性膀胱炎继发膀胱穿孔是一个非常罕见的过程，但在易感患者（有脓尿的老年糖尿病患者）急腹症的鉴别诊断中应予以考虑。在这种情况下，逆行膀胱造影可作出诊断。虽然腹膜外膀胱穿孔可通过膀胱导管或膀胱造瘘术解决，但感染尿液的外渗可能导致膀胱周围脓肿和感染性休克。这些病例应考虑早期手术治疗。
