膀胱自然破裂により発見された膀胱扁平上皮癌の1例

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A-90-year-old woman visited complaining of nausea, vomiting, and abdominal pain. She had abdominal rigidity and signs of generalized peritonitis. On computed tomography (CT) gastrointestinal perforation was denied and irregular thickness of the bladder wall was pointed out. Cystography was performed, but bladder rupture was not confirmed. Post-cystogram-CT revealed the leakage of contrast material in the peritoneal cavity from the urinary bladder. Spontaneous intraperitoneal bladder rupture was diagnosed. Cystoscopy was performed, but no information could be obtained due to severe cloudy urine. Open laparotomy was performed. At surgery, cloudy fluid was aspirated from the abdominal cavity. Abdominal organs were normal when explored, but a small perforation was found on the vault of the bladder and primary closure was performed. Postoperatively, cystoscopy was performed again after the medication with antibiotics. A huge, nonpapillary tumor was seen on the left lateral wall. Tumor biopsy was performed. Histological examination of specimens revealed squamous cell carcinoma. On abdominal CT, invasive bladder carcinoma, left hydronephrosis and hydroureter were pointed out. Considering her age, general health status and prognosis, only right ureterocutaneostomy was performed.
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