Abstract
We report on a case of rupture of the urinary bladder diagnosed on the basis of the presence of mesothelial cells in urine sediments. An eighty-year-old woman was admitted to our hospital with the complaint of back pain, and end-stage renal disease was suspected from her medical history and laboratory data. Massive proteinuria was detected in the urine test. RBCs, WBCs and casts were very few in the urinary sediments. In addition, oval cells were seen scattered or in small clusters, and cell-to-cell apposition was recognized at the points where cells are joined. Cells had nucleoli in mononuclei and multinuclei, but no hyperchromatin was seen in the nuclei. Therefore, we identified them as mesothelial cells from these findings. Five days after admission, ascites accumulated prominently, and serum BUN and CRE levels further increased. However, massive amounts of urine were excreted with urinary catheter use, and pooling ascites disappeared. No rupture sites were identified by contrast-enhanced CT, but were confirmed by cystoscopy. A few days later, her kidney function returned to normal with the use of an indwelling balloon catheter in the urinary bladder. This can be considered as an instructive case in terms of her medical history, that is, although rupture sites were not identified by contrast-enhanced CT, rupture of the urinary bladder was diagnosed on the basis of the findings in urine sediments.
