2005 Volume 38 Issue 12 Pages 1787-1791
The patient was a 73-year-old female who had been receiving maintenance hemodialysis due to diabetic nephropathy for 4 years. She was admitted to our hospital for amputation of the severely necrotic foot. During surgery, her blood pressure fell to 50/20mmHg temporarily. Five days after surgery, she developed high fever, and complained of lower abdominal pain and urgency of micturition. Laboratory data showed CRP of 30.2mg/dL, and white blood cell count of 11, 600/μL. On the day, her consciousness was disturbed, and the abdominal had became distended. Abdominal X-ray demonstrated massive air in the intestine, therefore, paralytic ileus was suspected. Abdominal pain exacerbated, and she subsequently died of sepsis. Autopsy demonstrated gangrenous cystitis with bladder perforation and pan-peritonitis. Beta 2-microglobulin derived amyloid was slightly deposited in the bladder wall. In this case, gangrenous cystitis appeared to be caused by ischemia of the bladder wall due to arterial sclerotic lesion, severe hypotension during the surgery and bladder overdistention by diabetic neurogenic bladder. Furthermore, chronic urinary tract infection, which had persisted under the condition of neurogenic bladder and anuria in this compromised host, probably influenced gangrenous cystitis.
