膀胱自然破裂4例の検討

Abstract

53歳女(症例1).下腹部痛, 血尿, 腎機能低下, 超音波検査で両側水腎症, 膀胱造影で放射線性膀胱炎による膀胱内血腫・膀胱外への造影剤溢流を認めた.膀胱内留置カテーテルで治療したが血腫が消退しないので腹腔ドレナージ・両側尿管皮膚瘻造設術を施行したが水腎症が増悪したため経皮的腎瘻造設術を施行した.65歳女(症例2).排尿時, 下腹部痛を認め, 徐々に痛みが増強し, 超音波, CTで骨盤内腹水を認めた.膀胱内カテーテルで腹痛・腹水は改善, 膀胱破裂閉鎖術を施行した.44歳女(症例3).下腹部痛を認め, 腸閉塞が疑れ, 超音波で腹水を認め, 膀胱内カテーテル留置で改善した.膀胱造影で造影剤腹腔内溢流を認め, 膀胱自然破裂と診断した.54歳女(症例4).腹部痛を認め, 急性腹膜炎が疑れ, 開腹手術で腹腔内洗浄, ダグラス窩にドレーン留置した.ドレーンからの排液を認め, 膀胱自然破裂と診断し膀胱内留置カテーテルを留置した

Between November 1997 and March 2001, 4 female patients from 44 to 65 years of age with a spontaneous rupture of the urinary bladder were analyzed. They complained of abdominal pain and had undergone an intra-pelvic gynecological operation (3 for uterine cancer, 1 for an ovarian cyst) several years before. The three with uterine cancer had also received radiation therapy. For their present condition, spontaneous urinary bladder rupture, their treatment was indwelling a urethral catheter. Two of them have had no recurrence of urinary bladder rupture after one month since having the urethral catheter indwelt. One, however, had to have the catheter re-indwelt due to unsuccessful suturing of the urinary bladder wall. The fourth patient had bilateral nephrostomy tubes due to severe radiation cystitis. Thus, one can infer that intra-pelvic gynecological operations and radiation therapy are major factors causing spontaneous urinary bladder rupture. While indwelling a urethral catheter may be effective for some patients with a spontaneous rupture of the urinary bladder, it may be very difficult to treat more complicated cases.