Abstract
A 77-year-old woman who had been on hemodialysis for chronic renal failure elsewhere presented to a previous hospital because of vomiting and abdominal pain, when she presented with hypotension and shock. She was referred to our hospital with a diagnosis of panperitonitis. A contrast-enhanced abdominal CT scan showed collection of ascites and bowel dilatation. Panperitonitis caused by bowel ischemia was suspected and an emergency operation was performed on the same day. During surgery, there was defluxion of massive white purulent fluid, but no abnormalities were found in the digestive tract. The wall of the urinary bladder extensively became necrotic, and two perforated sites were seen at the top of the bladder which changed to black in color. Simple cystectomy was performed with a diagnosis of necrosis and rupture of the urinary bladder. It was etiologically considered that rupture of the urinary bladder might occur due to gangrenous cystitis caused by chronic cystitis in a hemodialysis patient. Rupture of the urinary bladder caused by gangrenous cystitis is so rare that only five cases, including our case, have been reported in Japan, as far as we could review. Preoperative diagnosis was difficult and the prognosis was poor. We present this case, together with a review of the literature.
