Patient: 77-year-old Chinese man
Symptoms: Seven hours before admission to the hospital, the patient developed shortness of breath, abdominal pain, and “obvious” abdominal distension. He had problems with urination and defecation for about four days, and a week before hospitalization he was given antiviral and pain relief medication for a case of shingles affecting the lower back, sacrum, or base of the spine.
What happened next: In the emergency department, doctors discovered that the patient’s abdomen were “swelling and painful,” and there were signs of “large” fluid buildup, especially under the stomach. Around the base of the spine, there is visible skin damage from shingles, causing a painful rash of fluid-filled blisters. The man had high heart rate, blood pressure and breathing rate, but no fever. Although the amount of oxygen circulating in his blood was low, markers of inflammation and acid levels in the blood were elevated.
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Abdominal CT scans confirmed large amounts of fluid in the male pelvis and abdomen. After being transferred to the intensive care unit, the patient had a catheter placed, allowing bloody urine to pour straight out of his body for three hours. The doctor, who had already suspected that the man’s bladder could have ruptured, introduced blue dye into the catheter into the abdomen.
Diagnosis: The dye test also pointed to a rupture of the bladder, so doctors performed surgery to confirm and repair the problem. During the operation, they found a tear of approximately 0.8 inches (2 cm) in the bladder wall.
Treatment: The medical team repaired tears in the man’s bladder during surgery. They also placed the catheter and performed the bladder muscle. This allows urine to exit the bladder through a temporary opening in the abdominal wall. While recovering from surgery, the patient also took antiviral medications for several weeks to treat shingles.
“After undergoing surgery, the patient repaired his bladder and after receiving antiviral treatment, he regained full bladder function,” his doctor reported.
What makes the case unique is that “voluntary bladder rupture is a very rare urinary emergency that can be life-threatening,” the patient’s doctor wrote in the report. Common causes include chronic bladder infections, bladder obstruction, cancerous tumors, and cancerous treatments designed to kill tumors in the pelvic area.
However, in this case the rupture appeared to be caused by shingles. This is caused by the water cell herpes zoster virus. The same virus can cause chicken po, and after infecting chicken po, it can become dormant, hide in the nerves of the body, and later reactivate and cause shingles. (The reactivated virus is known as Herpes Zostar.)
A rare complication of shingles is urinary maintenance, either the bladder is not empty enough or it doesn’t empty at all when someone urinates. However, the male doctor believes this is the first time that the infection has led to a rupture of the bladder.
Urine subsidence occurs in about 4% of cases of shingles, but at a higher rate in patients where shingles affect the spine and sacrum. It is believed that complications can result from inflammation of the bladder, inflammation of nerves that connect to the bladder, or nerves near the spinal cord. This inflammation makes it difficult for the bladder wall to contract, thus emptying the urine.
In this patient, the history of diabetes may have complicated the picture, as both diabetes and shingles may have contributed to neurological problems that reduce the ability to feel the bladder is full. This could increase the chances of his bladder bursting when he’s full without seeking treatment early, doctors wrote.
“The risk of herpes zoster-related urinary dysfunction cannot be ignored,” they concluded. “Emergency intervention is needed.”
This article is for informational purposes only and is not intended to provide medical advice.
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