放射線性膀胱炎を原因とする膀胱破裂による汎発性腹膜炎の1例

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  • A CASE OF GENERALIZED PERITONITIS DUE TO A RUPTURE OF THE BLADDER CAUSED BY RADIATION CYSTITIS

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An 83-year-old woman was admitted to the department of gastroenterology in our hospital with a diagnosis of adhesive ileus following operation for a uterine cancer on July 22, 1997. Conservative therapy was started, but three days later, peritoneal signs appeared and white blood cell count and CRP level increased. An emergency operation was performed. Upon laparotomy, there were a large volume of ascites and a rupture of the bladder of which wall had become fragile. It was thought that the cause of rupture might result from radiation cystitis because she received irradiation after operation for the uterine cancer. Ruptured site of the bladder was sutured. Possible causes of the ileus were thought to be intestinal paralysis due to general-ized peritonitis and a narrowing of the ileum where inflammatory change was remarkable. For this, an excision of the ileum with ileostomy was performed. Thereafter a closure of the ileostomy and ileocolostomy were carried out. The patient had difficulty in management of evacuation for a while, but she was discharged on March 2, 1998.<br> Spontaneous rupture of the bladder is rare. This paper presents such a rare case caused by radiation cys-titis, together with 14 cases reported in Japan. It is thought that surgeons who manage acute abdomen may encounter the disease.

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