膀胱破裂を契機に発見された膀胱扁平上皮癌の1例

Abstract

71歳女性.患者は下腹部痛および両背部痛を主訴に, DIP・CTにて膀胱破裂の診断で緊急入院となった.入院時, 腹膜炎症状が強く, 膀胱鏡では膀胱内に瘻孔を認め, 瘻孔周囲には腫瘍性病変を認め, 生検にて癌真珠とその周囲に異型細胞がみられた.以上より, 膀胱扁平上皮癌による膀胱破裂と診断し, 両側尿管カテーテル留置, 抗生剤投与にて腹膜炎症状の改善後, 膀胱全摘除術を予定した.しかし, 開腹時には既に癌性腹膜炎の状態で根治術は不能と判断し, 両側尿管皮膚瘻による尿路変向術のみ行ったが, 術後イレウス・誤嚥性肺炎などを併発し, 術後約1ヵ月で死亡となった

A 71-year-old woman with pan-peritonitis was transferred to our hospital. Imaging studies showed the extravasation of contrast medium from the bladder to the intraperitoneal cavity, the right non-visualizing kidney and the left hydronephrosis. Cystoscopy revealed bladder stones and a fistula at the posterior wall of the bladder. A histological examination of specimen around the fistula revealed squamous cell carcinoma(SCC) with stromal invasion. Symptoms of peritonitis subsided following the placement of bilateral ureteral catheters and a urethral catheter. Because a laparotomy revealed peritonitis-carcinomatosa, she underwent bilateral ureterocutaneostomies, the removal of the bladder stones and the primary closure of the fistula. She died on the 42nd day after surgery.