虫垂炎穿孔による膀胱周囲膿瘍の1例

Abstract

A 38 year-old man was referred to our hospital for high fever and lower abdominal pain. The laboratory data showed his inflammatory state with a few puss cells in the urine analysis. Computed tomography (CT) scan and magnetic resonance imaging (MRI) scan demonstrated perivesical abscess and the cystoscopy on the day just before the operation revealed no abnormal findings in the bladder mucosa. In the operation, under the preoperative diagnosis of pyourachus, the appendix with the tip open was found inside the abscess cavity. Therefore, appendectomy and partial cystecomy were carried out. On the grounds of the pathological findings ; remarkable inflammatory change in the perivesical fatty tissue and slight inflammatory lesions in the subserous layer of the appendix, in addition to the clinical course and the retrospective findings of the preoperative MRI scan : existence of a tubular structure connecting with the abscess cavity, the final diagnosis was made as perivesical abscess secondary to ruptured appendicitis. This case is reported with a brief discussion as to the diagnosis and treatment.