手術が必要となった腹膜外膀胱破裂の１例

• Published in: Journal of the Japanese Association for the Surgery of Trauma Vol. 29; no. 3; pp. 368 - 371
• Main Authors: 山村 英治, 松田 潔, 望月 徹, 菊池 広子, 石丸 直樹, 橋詰 哲広, 遠藤 広史, 笠井 華子, 黒川 顕
• Format: Journal Article
• Language: Japanese
• Published: 一般社団法人 日本外傷学会 2015; The Japanese Association for the Surgery of Trauma
• Subjects: bladder injury; blunt trauma; crash trauma; 墜落外傷; 膀胱損傷; 鈍的外傷
• DOI: 10.11382/jjast.29.368
• ISSN: 1340-6264

We treated a case of traumatic extraperitoneal bladder rupture and achieved a good clinical outcome via surgical operation. The patient, a 70-year-old female, had jumped from the 2nd floor of a building in order to commit suicide. Contrast computed tomography images showed disruption of the bladder wall, and extravasation of contrast medium was observed. After tests, the vital signs showed that the patient had gone into shock, and emergency surgery was performed. We repaired an 8-cm-long injury of the anterior bladder wall. The postoperative course was favorable. A contrasted cystogram was obtained 3 weeks postoperatively. We confirmed that there was no leakage of contrast medium from the bladder wall. The patient had extraperitoneal bladder rupture complicating a pelvic fracture, and a pessary may have caused enlargement of the injury site. We selected surgical operation for this case of extraperitoneal bladder rupture and achieved a favorable clinical outcome. 外傷性腹膜外膀胱破裂に対して手術を施行して良好な経過を得た症例を経験した．症例は70歳，女性．自殺目的で自宅の２階から飛び降りて受傷．来院時は意識清明でバイタルサインは安定．造影CTで膀胱壁は途絶し，周囲に造影剤血管外漏出像を認めた．検査後にショックとなり，緊急手術となった．膀胱前壁の８cmの損傷部を修復した．術後経過は良好．術後３週目に膀胱造影を施行し，膀胱壁からの造影剤漏出がないことを確認して膀胱留置カテーテルを抜去．本症例は，骨盤骨折に合併した腹膜外破裂であり，ペッサリーが損傷部拡大の一因となった可能性が考えられた．手術を選択して良好な経過を得られた腹膜外破裂症例であった．