気腫性膀胱炎の1例

Abstract

86歳女。無症候性肉眼的血尿、排尿困難を主訴とした。尿所見上、肉眼的血膿尿があり、尿培養にて大腸菌が検出された。膀胱鏡所見で粘膜は全周性に発赤、白苔を伴ない気、気泡の形成を認めた。気腫性膀胱炎の診断にて緊急入院となり、来院時、尿閉状態であったため尿道バルーンカテーテルを留置し、SBT/ABPC 3g/dayの点滴を開始した。CTでは膀胱内および膀胱壁に沿ったガス像と鏡面像を認めた。入院後2日目には血尿は消失し、入院3週間後の骨盤CTでは膀胱内の気泡消失を認めた。入院4週間後にバルーンを抜去し、その後自排尿可能となった。

A 86-year-old woman presented with asymptomatic gross hematuria, and visited our hospital, and a vesicorectal fistula was suspected from a computed tomographic (CT) scan. She had a lower abdominal mass and urinary retention on arrival. Pclvic CT demonstrated intramural gas in the urinary bladder, which suggested a diagnosis of emphysematous cystitis. Cystoscopy demonstrated reddish mucosa and gas within the bladder wall. The gross hematuria was improved and the intramural gas disappeared on a CT scan after urinary drainage and antibiotic therapy. Although emphysematous cystitis is almost always cured with conservative therapy, an accurate diagonosis and prompt treatment are required because rarely emphysematous cystitis can result in rupture of the urinary bladder and lead to septic shock.