著者

田中 一志 武中 篤 楠田 雄司 原口 貴弘 山中 望

出版者

泌尿器科紀要刊行会

雑誌

泌尿器科紀要 (ISSN:00181994)

巻号頁・発行日

vol.48, no.12, pp.741-744, 2002-12

被引用文献数

5 7

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80歳女.肉眼的血尿,嘔吐が出現し,膀胱鏡で全周性に粘膜の発赤,出血と気泡の形成を認めた.高度の炎症所見,高血糖,脱水を認め,補液,セフォゾプラン投与,レギュラーインシュリンを行った.その後全身倦怠感が増悪し,血液ガス所見で代謝性アシドーシスを認め,意識レベルが低下した.CTで膀胱壁内に著明なガス像を認め,緊急膀胱摘出及び尿管皮膚瘻造設術を行った.膀胱粘膜は全周にわたり暗赤色,浮腫状に変性しており,尿培養及び組織表面の細菌培養でEscherichia coliを認めた.病理所見で,粘膜の上皮細胞はほぼ壊死となって脱落しており,粘膜から粘膜下組織にかけて出血,壊死性の像を認めた.又,粘膜下組織には発生したガスによる著明な大小の腔隙を認めた.術後経過良好で,退院し糖尿病外来治療となったA 80-year-old female with insulin-dependent diabetes mellitus (IDDM) visited our hospital on November 24, 1999, because of nausea, vomiting and macrohematuria. Cystoscopy demonstrated a diffuse hyperemic mucosa and gas-filled vesicles in the submucosa. Despite treatment with antibiotics, infection was not controlled and metabolic acidosis was increased. Simple cystectomy and ureterocutaneostomy were performed. Histological examination showed whole mucosal necrosis and vacuolation with aerogenesis in the submucosa and muscle layer of the bladder. Urine and mucosal surface cultures revealed Escherichia coli infection. After operation, the general condition was improved. Thirty six cases of emphysematous cystitis have been reported in Japan including this case. Successful treatment with cystectomy under the life threatening condition was reported for the first time.