破裂前に骨盤部MRIで憩室の詳細な評価をしえた膀胱憩室自然破裂

Detailed evaluation of the diverticulum performed by pelvic MRI for bladder diverticulum spontaneous rupture

　78歳男性．尿閉に対して尿道カテーテルを留置．その後，カテーテルを抜去のうえ自己導尿を開始したが，腹満感を主訴に再診．精査にて多量の腹水および膀胱頂部憩室の穿孔を認めた．外傷や転倒の既往を認めず，膀胱憩室自然破裂の診断にて，憩室切除術を施行．術後は自排尿が可能となった．膀胱憩室の自然破裂はまれだが，死亡例の報告もあり，ハイリスク症例に対しては，予防的な憩室切除術も検討すべきと考える．

Abstract

The patient was a 78-year-old man with a complaint of lower abdominal pain. Urethral catheter was inserted due to a urinary retention. After the catheter was removed, clean intermittent catheterization was used for bladder drainage.

At three days after the start of clean intermittent catheterization, he was admitted to our hospital again with a complaint of abdominal bloating. Blood tests showed acute renal failure and higher inflammatory marker levels. After Computed Tomography showed excessive ascites, he was diagnosed with raptured bladder diverticulum using the subsequent cystoscopy. During surgery, we recognized two bladder diverticula around the bladder top and one of them had the rupture. The diverticula were removed from bladder and it was repaired. After surgery, he could void urine spontaneously without a catheter. Although spontaneous rupture of a bladder diverticulum is rare, clinicians should assess a risk of the rupture and consider diverticulectomy for high-risk patients (Rinsho Hinyokika 75: 447-451, 2021).