tuberculous bladder spontaneous rupture
Introduction
Introduction to spontaneous rupture of tuberculous bladder Spontaneous rupture of tuberculous bladder is rare, but it is the first in spontaneous bladder rupture. According to the 80 cases of spontaneous bladder rupture commemorated by European and American literature, the most cases occurred in bladder tuberculosis, accounting for 12.5% of 10 cases, and 11 cases of spontaneous bladder rupture reported by domestically produced bladder tuberculosis. There were 4 cases of tuberculosis in 5 cases of spontaneous bladder rupture admitted to our hospital from 1970 to 1975. Therefore, clinical attention should be paid. The age of onset of this disease is mostly between the ages of 15 and 25. There was no significant difference in gender data, but 15 cases of tuberculous bladder spontaneous rupture in domestic data were female. basic knowledge Sickness ratio: 0.0001% Susceptible people: good women Mode of infection: non-infectious Complications: kidney tuberculosis
Cause
Causes of spontaneous rupture of tuberculous bladder
Bladder tuberculosis (40%):
The cause of self-rupture of bladder tuberculosis is mainly due to the fact that the lesions of bladder tuberculosis often involve the whole layer of the bladder. If there is a factor of lower-layer obstruction and sudden increase in intra-abdominal pressure, it can cause rupture. Spontaneous rupture of tuberculous bladder is almost intraperitoneal. The ruptured area is mostly at the top or back of the bladder.
Increased intra-abdominal pressure (20%):
Because of the lesions of bladder tuberculosis, the whole layer of the bladder often causes rupture. In addition to tuberculosis, factors that increase intra-abdominal pressure can cause spontaneous rupture of the bladder, such as constipation, lower urinary tract obstruction, tumor, and drunkenness. Therefore, early treatment of early onset and avoiding other concurrent and secondary diseases are also important preventive and health measures.
Kidney tuberculosis (10%):
Kidney tuberculosis patients with acute abdomen symptoms, and the following abdomen is obvious. As the bladder ruptures, urine continuously flows into the abdominal cavity, so it often has ascites. Diagnostic abdominal puncture can extract more yellow liquid.
Prevention
Tuberculous bladder spontaneous rupture prevention
Some data indicate that in addition to tuberculosis, other factors that increase intra-abdominal pressure can cause spontaneous rupture of the bladder, such as constipation, lower urinary tract obstruction, tumor, drunkenness, etc., so early treatment of early onset, avoiding other concurrent and secondary diseases is also important. Preventive health measures, and avoidable factors such as drunkenness are avoided as much as possible.
Complication
Tuberculous bladder spontaneous rupture complications Complications, kidney tuberculosis
Tuberculous bladder spontaneous rupture is a serious late complication of renal tuberculosis.
Symptom
Spontaneous rupture of tuberculous bladder Symptoms Common symptoms Abdominal pain Acute abdomen Ascites Intestinal bladder Bladder tuberculosis Peritonitis Anuria peritoneal irritation
The disease has the characteristics of acute onset, critical illness, complexity, etc., often misdiagnosed as other acute abdomen, sudden abdominal pain in the absence of trauma in the absence of trauma, no history of urination after the onset or only a small amount of hematuria, abdomen If there is a sign of peritoneal irritation, the disease should be considered, and the history of urinary tuberculosis should be investigated. The peritoneal irritation can be found when the body is examined, but the degree is not serious. The abdominal part is often obvious, and the bowel sounds do not disappear. The characteristics may be related to the bladder as a pelvic organ. The rupture of the urinary peritonitis causes the peritoneal and intestinal tract to be less irritating than the general purulent peritonitis, and the spread is related to the bottom-up. Because the urine continues to flow into the abdominal cavity after the rupture of the bladder tuberculosis, Therefore, the ascites sign is often positive, more than the yellow liquid can be extracted by abdominal puncture. Diagnostic catheterization often has no urine output, or only a small amount of bloody urine is derived. The amount of fluid returned during the bladder injection test is significantly reduced compared with the injection volume. However, if the catheter enters the abdominal cavity, the amount of fluid returned will increase significantly. If necessary, bladder angiography can be used to confirm the diagnosis. If the diagnosis is still uncertain, early laparotomy should be performed to avoid delay. Time.
Tuberculous bladder spontaneous rupture is a serious complication of advanced tuberculosis. In order to further clarify the upper urinary tract disease, the upper urinary system must be performed. Because of the difficulty in urography during advanced urinary tract angiography, it is often allowed. The two kidneys should be explored at the same time as the emergency surgery to detect the bladder disease, and the rouge test should be used. This has important reference value for the diagnosis of the cause and the subsequent treatment.
Examine
Spontaneous rupture of tuberculous bladder
Ultrasound, cystography, rouge test.
Diagnosis
Diagnosis and diagnosis of spontaneous rupture of tuberculous bladder
diagnosis
In the absence of trauma, sudden abdominal pain in the absence of trauma, no history of urination after the onset or only a small amount of hematuria, abdominal periplasmic signs, should consider the disease, and ask whether there is a history of urinary tuberculosis, check The peritoneal irritation can be found in the body, but the degree is not serious, often the abdomen is obvious, and the bowel sounds do not disappear.
Differential diagnosis
Often misdiagnosed as other acute abdomen.
