以假性肾衰竭为表现的婴幼儿膀胱破裂1例并文献复习

A case of bladder rupture in infant initially diagnosed with pseudo-renal failure and litereture review

目的探讨假性肾衰竭的少见病因、小儿膀胱破裂的临床特征及诊治方案.方法根据患儿的临床特征、实验室检查、影像学检查及治疗后病情变化,考虑膀胱破裂可能,行开腹探查术明确.结果2岁女童,急性起病,以呕吐、腹水、无尿就诊,诊断急性肾衰竭,经导尿大量淡红色尿液后,腹水迅速减少,24小时内血肌酐及尿素正常.经增强CT扫描示肝肾隐窝、肠间隙、双侧髂窝区及膀胱后方高密度影,考虑对比剂外渗.行开腹探查手术明确膀胱破裂诊断并缝合破裂口.术后2周拔除导尿管,患儿排尿正常,无血尿、腹胀,监测血肌酐正常,B超未见腹水,提示膀胱裂口愈合.结论婴幼儿出现急性肾衰竭表现,当常规病因无法解释病情时应注意膀胱破裂可能,及时影像学检查有助于早期识别.

Objective To investigate the rare etiology of pseudo-renal failure and to expllore the clinical characteristics,diagnosis and treatment of bladder rupture in children.Methods According to the clinical characteristics,laboratory examination,imaging examination and the changes of the condition after treatment,the possibility of bladder rupture was considered,and the possibility of bladder rupture was confirmed by laparotomy.Results A 2-year-old girl with acute onset was diagnosed with acute renal failure by presenting with vomiting,ascites and anuria.After performing catheterization and observing a substantial volume of pale red urine,there was a rapid reduction in ascites,and the levels of blood creatinine and urea returned to normal within 24 hours.The enhanced CT scan revealed hyperdense opacities in the recesses of the liver and kidney,intestinal space,bilateral iliac fossa area,and posterior bladder.An exploratory laparotomy was performed to confirm the diagnosis of bladder rupture and repair the tear.The catheter was removed two weeks post-surgery,resulting in normal urination,absence of hematuria,no abdominal distension,normal serum creatinine levels,and absence of ascites as detected by B-ultrasonography-indicating successful healing of the bladder tear.Conclusion In cases of acute renal failure in infants and young children,it is important to consider the possibility of bladder rupture when conventional causes cannot explain the condition.Timely imaging aids in early detection.