MULTIPLE BLADDER STONES AND SEVERE URETHRAL INJURY IN A PATIENT WITH ACUTE ABDOMEN: A CASE REPORT

Öz

Bladder stones are very common in the elderly population with lower urinary tract obstruction, and they are associated with adverse outcomes such as recurrent infections and lower urinary tract obstruction. Managing bladder stones has traditionally been done using open procedures such as a cystolithotomy or endoscopic removal. The objective of the study is to present a rare case of multiple bladder stones in a surgical emergency where urinary diversion was mandatory, as endoscopic manipulation appeared impossible—for an 85-year-old man who presented with acute abdomen symptoms, hemodynamically unstable severe urethral injury, and multiple bladder stones. Abdominopelvic non-contrast computerized tomography (NCCT) showed free fluid in the abdomen, gas in the bladder, and numerous bladder stones. Emergency surgery was performed on the patient, and the preexisting perforated stomach ulcer was surgically reconstructed. For urinary diversion, the decision was made to perform open cystolithotomy to eliminate more than 84 bladder stones of different shapes and sizes. We placed a urinary catheter using a Benique bougie and performed the cystostomy to open a second route.

Anahtar Kelimeler

• Bladder stones
• urethral injury
• acute abdomen

AKUT KARIN TABLOSUNDAKİ BİR HASTADA ÇOKLU MESANE TAŞLARI VE AĞIR ÜRETRA YARALANMASI, OLGU SUNUMU

Öz

Mesane taşları, alt üriner sistem obstrüksiyonu olan yaşlı popülasyonda çok yaygındır ve tekrarlayan enfeksiyonlar ve alt üriner sistem obstrüksiyonu gibi olumsuz sonuçlarla ilişkilidir. Mesane taşlarının yönetimi geleneksel olarak sistolitotomi gibi açık tekniklerle veya endoskopik olarak çıkarılmasıyla yapılmaktadır. Çalışmanın amacı, çoklu mesane taşı olan ve endoskopik manüpulasyon yapılamadığndan üriner diversiyon yapılması için acil cerrahi müdahale gerektiren nadir bir olgununun sunulmasıdır. Akut abdominal bulguları olan 85 yaşındaki erkek olgunun hemodinamik olarak stabil olmayan ağır üretral hasarı bulunmaktaydı. Abdominopelvik kontrastsız bilgisayarlı tomografide (NCCT) batında serbest sıvı, mesanede gaz ve çok sayıda mesane taşı görüldü. Acil cerrahiye alınan hastanın önceden var olan ve perfore olmuş mide ülserine müdahale yapıldı. Farklı şekil ve boyuttaki 84’den fazla taşın alınması için uygulanacak üriner diversiyonun açık sistolitotomi şeklinde yapılmasına karar verildi. Benique buji kullanılarak üriner kateter yerleştirildi ve ikinci bir yol açmak amacı ile sistostomi uygulandı.

Anahtar Kelimeler

• Mesane taşları
• uretral yaralanma
• akut karın

Kaynakça

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