気腫性膀胱炎の1例

Abstract

60歳女性.患者は慢性関節リウマチ, アミロイドーシス, ステロイド長期服用に伴う糖尿病の経過中, 肉眼的血尿, 下腹部痛が出現し, 著者らの施設へ紹介となった.尿細菌培養はEscherichia coli 2+, 尿細胞診は陰性で, KUBにて膀胱辺縁に沿ったガス像と膀胱部の透過性の亢進を認めた.経腹的膀胱部超音波検査ではガスによるアーチファクトのため内腔は不明で, 膀胱鏡では粘膜全体に発赤, 多数の気泡を認めた.以上より, 気腫性膀胱炎と診断し, 抗菌剤投与にて経過観察を行ったが, 1ヵ月後の超音波では両側水腎症, 膀胱内の尿貯留を認めた.神経因性膀胱による尿閉と判断し, 膀胱内留置カテーテルによる尿路管理を行った結果, 両側水腎症は消失した

A 60-year-old woman visited our clinic with a complaint of gross hematuria. She was under treatment for rheumatoid arthritis, amyloidosis and diabetes mellitus at the Departments of Orthopedic Surgery and Internal Medicine. The results of a urine analysis showed protein urine, glucose urine, hematopyuria and bacteriuria. The diagnosis of emphysematous cystitis was made from radiography, ultrasonogram and cystoscopic findings. Antibiotics were administered effectively. However, one month later, bilateral hydronephrosis was identified by a computed tomographic scan performed by the Department of Internal Medicine. The bilateral hydronephrosis was brought on by urinary retention caused by a neurogenic bladder disorder. Thus, an indwelling catheter followed by intermittent catheterization was performed and cholinergic medication prescribed successfully.