全腹腔鏡下子宮全摘出術後に遅発性の膀胱損傷を生じ偽性腎不全を呈した1例

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  Pseudo-renal failure is a rare condition with laboratory abnormalities mimicking acute kidney injury despite normal kidney function. When upper or lower urinary tract injury causes intraperitoneal urine leakage, reverse intraperitoneal urine dialysis leads to elevated levels of blood urea nitrogen and creatinine, hyperkalemia, and metabolic acidosis. We report a case of pseudo-renal failure with delayed bladder injury after total laparoscopic hysterectomy (TLH). A 52-year-old woman visited our hospital for treatment of multiple uterine myoma, for whom TLH was performed. After surgery, she had no urination desire and was made to urinate using urethral catheters as appropriate. After 3 days of surgery, laboratory findings showed elevated serum creatinine level. A urethral catheter was indwelled, the creatinine level improved. However, the creatinine level increased again after removal of the urethral catheter. Abdominal computed tomography (CT) showed presence of several ascites and cystoscopy showed a perforated bladder. After 6 days, bladder repair surgery was performed.

  Bladder injury is one of the complications to be avoided in TLH. If the uterus is large, the surgery is more difficult and the risk of bladder injury is higher. In this case, uterus was large and there was an anatomical change due to a broad ligament myoma. The bladder injury occurred when the bladder was detached from the lower uterine segment. In general, cystoscopy and CT cystography are useful for identifying bladder injury due to pelvic surgery. This case suggests that pseudo-renal failure is an indication of bladder injury after pelvic surgery.