Ivchev, Jovan and Ivchev, Ljubomir (2020) Surgical Treatment of Gangrene of the Urine Bladder, Review of Three Cases. Merit Research Journal of Medicine and Medical Sciences, 8 (4). pp. 101-105. ISSN 2354-323X
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Abstract
Gangrene of the urine bladder is a very rare life threatening acute urology disease that
requires extremely fast diagnoses followed by urgent and radical surgical treatment.
Fronstein once noticed that gangrene of the urine bladder is so rare that it should be
described each appearance as a separate case. The first such case was described in 1650
by Willis (Carson, 1925). Two etiology factors have so far been described mostly for the
occurrence of the vesical gangrene. The first is the gangrenous cystitis that occurs in
untreated acute cystitis in patients with reduced immunity or in female who developed
gangrenous cystitis post-partum (Prabhat et al., 2019), and the second factor is described
as a complication after embolization of the hypogastric artery or complication during
pelvic thrombophlebitis (Sieber, 1994). In majority of cases described, surgical treatment
consisted of partial or total cystectomy and temporary urinary derivation (Stirling and
Hopkins, 1934). The aims of the study was to analyze the diagnostic methods, operative
and post-operative treatment and follow-up of the patients with gangrene of the urine
bladder treated at our urology department. The results obtained was compared with the
existing data in the world literature and relevant scientific papers and determine the
justification for second surgical intervention in order perform definitive urinary derivation
with ileal conduit. Three consecutive cases of vesical gangrene have been treated in the
past 18 months at the Urology Department at the General City Hospital “8th September” –
Skopje, R of North Macedonia. All three were admitted as acute abdomen with septic
condition and treated at the Emergency Center. Two of them were treated due to complete
vesical gangrene and the third was treated first as acute abdomen caused by fibrotic
obstruction of the sygma as a complication after radiation therapy received for cervical
cancer. The third case was treated for vesical gangrene developed eight months after the
first surgery as a complication due to persistent recto-vesico-vaginal fistula. The
intraoperative finding revealed acute phlegmonoso-gangrenous peritonitis caused by
complete gangrene and perforation of the urine bladder in two cases, and partial vesical
gangrene with vesico-recto-vaginal fistula developed eight months after partial resection
and colostomy in the third case. Emergency surgery with radical cystectomy and
ureterocutaneostomy was performed on the patients with complete gangrene and
perforation of the urine bladder. The third patient was treated as complication of
persistent urinary infection due to recto-vesico-vaginal fistula and performed radical
cystectomy with ileal conduit as permanent urinary derivation. Six months after the
emergency surgery urinary diversion with ileal conduit was performed in one of the
patients due to complete stenosis of the ureterocutaneostomy and acute obstructive renal
failure with metabolic acidosis. The two years’ post operative follow up showed good
health with normal function of the ileostoma in both patients and normal function of the
ureterocutaneostoma in one patient with normal values of the electrolytes and blood
degradation products. Urine bladder gangrene is rare but extremely urgent life
threatening condition which requires radical surgical treatment during the first 24 hours
from its appearance. Acute occlusion of one of the hypogastric arteries with thromb
embolus, as a complication of pelvic phlebothrombosis, according to our experience is
the most common cause for its appearance. Long presence of vesico-rectal or vesicovagino-
rectal fistula could also result with partial necrosis of the urine bladder wall. But
unlike the acute occlusion of the hypogastric artery, it has chronic symptoms and signs.
Urgent radical cystectomy with bilateral ureterocutaneostomy in the first stage and
urinary diversion with ileal conduit in second stage is so far the most convenient surgical
solution for these acute urinary conditions
| Item Type: | Article |
|---|---|
| Impact Factor Value: | 1,425 |
| Subjects: | Medical and Health Sciences > Basic medicine Medical and Health Sciences > Clinical medicine Medical and Health Sciences > Health sciences |
| Divisions: | Faculty of Medical Science |
| Depositing User: | Jovan Ivcev |
| Date Deposited: | 21 May 2020 09:37 |
| Last Modified: | 21 May 2020 09:37 |
| URI: | https://eprints.ugd.edu.mk/id/eprint/24048 |
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