膀胱內假牙: 一病例報告
林昌民、闕舜仁、白彝維、陳永泰、陳日昇、陳欣宏
基督復臨安息日會醫療財團法人臺安醫院 外科部 泌尿科
False tooth in the urinary bladder: A case report
Chang-Min Lin, Leonard S. Chuech, Yi-Wei Pai,
Tung-Tai Chen, Jih-Sheng Chen, Shin-Hong Chen
Divisions of Urology, Department of Surgery, Taiwan Adventist Hospital, Taipei, Taiwan
Purpose:
We report a patient was found with one false tooth in the urinary bladder incidentally during cystoscopic surgery.
Case report:
A 84-year-old female had histories of hypertension, type 2 diabetes mellitus, senile dementia and ever received ventriculoperitoneal shunt due to intracranial hemorrhage and hydrocephalus 4 years ago. She was bedridden and lived in respiratory care ward after tracheostomy since 4 years ago. She was presented to the emergency department complaining of gross hematuria and decreased urine amount for one day. Her blood pressure, pulse rate, and temperature were 84/49 mmHg, 85 per minute, and 35.7°C. Abdominal examination found distention of lower abdomen with tenderness. Laboratory results were leukocytosis (white blood count was 41,200 cells/mm3)and pyuria (WBC>100 /HPF). C-reactive protein level was 41.2 mg/dL. Abdominal plain film revealed one calcified lesion in the pelvic cavity. She was admitted to intensive care unit under the impression of urinary tract infection with septic shock. Due to obstruction of Foley catheter by blood clots, urologist was consulted. Then cystoscopic removal of blood clots was done. During operation, about 500mL blood clots were evacuated and one false tooth was found in the urinary bladder incidentally. Multiple bladder tumors over also noted, and bladder biopsies were performed. The pathological report of bladder tumor was adenocarcinoma. After her vital sign was stabilized, abdominal CT scan was done and it showed tumor of Sigmoid colon with bladder invasion. General surgeon perform colostomy for her and ischemic change over transverse colon was noted. After operation, her septic shock was progressed and multiple organ failure was noted. Then the patient died on the 13th day after admission.
Discussion:
Intravesical foreign bodies usually result from iatrogenic injuries, self-insertion, sexual abuse, assault, and migration from adjacent sites, although migration from adjacent sites is rare, and migration from oral cavity is extremely rare. A wide range of foreign bodies has been reported in the urinary bladder, including electrical wires, chicken bones, wooden sticks, thermometers, bullets, intrauterine contraceptive devices (IUCDs), encrusted sutures, surgical staples with stones, needles, pencils, household batteries, gauze, screws, pessaries, ribbon gauze, parts of Foley catheters, broken parts of endoscopic instruments, and knotted suprapubic catheters. Urinary tract infection, pain, and haematuria are the usual chief complaints. X-ray imaging detects radiopaque foreign bodies, while other foreign bodies are usually detected through ultrasonography. With advances in endoscopic techniques, open surgery is not usually required, and the majority of cases can be treated using minimally invasive techniques. We reported the case was found with one false tooth in the urinary bladder incidentally during cystoscopic surgery. The false tooth maybe migrated from oral cavity to intestine initially, and then into the urinary bladder through the tumor of sigmoid colon noted by abdominal CT scan.