保存的治療が可能であった再発性膀胱自然破裂の1例

Abstract

44歳女.1989年に頸癌にて広汎子宮全摘術, 術後放射線療法を施行され, 術後より排尿困難を自覚していたが, 1998年に尿閉と急性腹症を発症した.画像所見より放射線療法による膀胱壁脆弱化に加え, 術後神経因性膀胱による膀胱壁過進展, 内圧が原因で膀胱破裂を発症したものと考えられた.尿ドレナージのため, 先端が軟らかく可動性のある14Frサフィードネラトンカテーテルを留置し, その後保存的治療にて腹痛, 発熱, 全身状態は改善した.2000年に同様の症状が出現し, 膀胱鏡検査及び膀胱造影から膀胱自然破裂再発と診断し, 保存的治療を行い軽快した.経過観察中であるが, 再々破裂は認めていない

The patient was a 44-year-old woman, who had undergone radical hysterectomy and postoperative radiation therapy for cervical cancer at the age of 34 years old. In 1998, she was admitted to our hospital with chief complaints of acute abdominal pain and high fever. We made a diagnosis of spontaneous bladder rupture associated with neurogenic bladder dysfunction and radiation cystitis, based on findings of cystoscopy and cystography. She was cured by conservative therapy, including catheter drainage and antibacterial chemotherapy. Thereafter, she was managed with intermittent self-catheterization. In 2000, spontaneous bladder rupture recurred, but conservative therapy was effective again. A review of 12 cases of recurrent spontaneous bladder rupture in Japan, including the present case, suggests that proper management of urination for neurogenic bladder dysfunction may be necessary for prevention of recurrent rupture, when the impaired bladder is left after either successful conservative or surgical treatment of bladder rupture. Urinary diversion and augmentation cystoplasty should be considered for repeated rupture of the bladder.