腹腔鏡下手術を施行した腹腔内遊離ガスを伴った膀胱自然破裂の1例

Spontaneous Rupture of Urinary Bladder with Pneumoperitoneum : A Case Report of Laparoscopic Repair

　腹腔内遊離ガス（free air）を伴った膀胱自然破裂に対し，腹腔鏡下手術を施行したので報告した．症例は50歳，男性．飲酒後に腹痛が出現し，近医を受診した．腹部単純X線上でfree airを認めたため，消化管穿孔の疑いで紹介となった．上部消化管穿孔を疑い緊急内視鏡を施行したが，胃潰瘍，十二指腸潰瘍は認めなかった．原発不明であるが，消化管穿孔による汎発性腹膜炎の診断で緊急腹腔鏡下手術を施行した．膀胱頂部から後壁にかけて約5cmの破裂創を認め，膀胱破裂の診断をした．破裂部を腹腔鏡下に連続縫合閉鎖した．

We report a case of spontaneous rupture of urinary bladder with Pneumoperitoneum (free air), successfully treated by laparoscopic approach. A 50-year-old man visited a nearby hospital complaining of abdominal pain after drinking. Abdominal X-ray film revealed free air, so he was refered to our hospital under suspicion of gas-trointestinal perforation. No positive findings were obtained from upper gastrointestinal endoscopy. Under a di-agnosis of panperitonitis due to unknown origin, we opted for a laparoscopic approach.