急性腹症を呈さなかった膀胱自然破裂

INTRAPERITONEAL SPONTANEOUS RUPTURE OF THE URINARY BLADDER WITHOUT PERITONITIS

　75歳，女性。広汎子宮全摘術後の神経因性膀胱に放射線障害を併発し，腹腔内膀胱自然破裂を生じた。腹部膨満と排尿困難を呈したが，急激な腹部症状はみず，慢性に経過した。腹腔鏡で診断を確定し，大網補填による修復を行い，良好な経過をたどった。病的膀胱における排尿管理の重要性と自己導尿の意義を強調した。

A 75-year-old female was hospitalized with marked abdominal distension and dysuria. She had post-operative pelvic irradiation for uterus cancer 12 years ago, and suffered from neurogenic voiding dysfunctionand radiation cystitis. Laparoscopy revealed intraperitoneal rupture of the bladder without peritonitis oromental involvement. Surgical closure with omental interposition between the bladder and the peritoneumwas successful, followed by intermittent self-catheterization.