膀胱結石引起之黏膜下血管瘤出血造成膀胱填塞之病例報告
林柏宏、馮思中、劉忠一、甘弘成、虞凱傑、邵翊紘、張英勛、莊正鏗
林口長庚醫院 泌尿科
Case report: bladder tamponade induced by submucosal aneurysm bleeding resulted from bladder stone
Po-Hung Lin, Jacob See-Tong Pang, Chung-Yi Liu, Hung-Cheng Kan, Kai-Jie Yu, I-Hung Shao, Ying-Hsu Chang, Cheng-Keng Chuang
Division of Urology, Department of surgery, Chang Gung Memorial Hospital at Linkou
A 75-year-old female presented to emergency department with hematuria, lower abdominal fullness and difficulty in voiding for days. She has diabetes and hypertension. She denied lower urinary tract symptoms before this event. The bedside echo revealed soft tissue echogenicity in bladder with suspicion of blood clot or bladder tumor. A hyperechoic lesion with acoustic shadow was also noted. She was sent to operation room for bladder tamponade.
After evacuation of all the blood clot, a bladder stone was noted. There was no bladder tumor found but a pulsatile bleeder was found at the trigone of bladder. An aneurysm with bleeding was suspect and hemostasis was done with electrocauterization. Then the bladder stone was disintegrated and evacuated. After the operation, the patient encountered urine retention. We gave bethanechol with Foley training and her bladder function recovered gradually.
In conclusion, the patient has bladder dysfunction due to DM-related neurogenic bladder. There was possible high residual urine volume and bladder stone formed. The stone chronically stimulated the bladder mucosa and caused a submucosa aneurysm. At the event happened, the aneurysm ruptured and the arterial bleeding cannot stop spontaneously and resulted in bladder tamponade. We shared the experience of treating patient with the rare condition.