Abstract
A 35-year-old woman who had undergone extended hysterectomy for cancer of the cervix followed by radiation therapy 5 years earlier was brought into our hospital by ambulance because of the abrupt onset of lower abdominal pain. There was rebound tenderness in the lower abdomen, and increased inflammatory reaction and high Cr value were noted by blood tests. An abdominal CT scan revealed massive ascites in the surroundings of the left kidney and in the pelvic cavity. Peritonitis due to extravasated urine was suspected from her previous history. We thus performed a plain CT scan 30 min after an enhanced CT scan and confirmed intraabdominal extravasation of contrast medium. Spontaneous rupture of the urinary bladder was diagnosed by cystography and cystoscopy. We conducted drainage of the urine retained in the abdominal cavity and placed a urinary catheter in the bladder. Prompt symptomatic remission was gained, the catheter could be removed on the 14th postoperative day, and the patient was discharged on the 19th POD.
The correct diagnosing rate of spontaneous rupture of the urinary bladder after irradiation is low and not the least patients have been treated without being diagnosed. In this case, our study conducting enhanced CT followed by plain CT scanning with an interval clarified radiation-induced spontaneous rupture of the urinary bladder before treatment. We must keep in mind that patients who have received intrapelvic irradiation can develop peritonitis caused by extravasated urine.
