Göbekte Akıntı ile Başvuran 5 Yaşında Kız Olgu
Özet
Beş yaşında nörojen mesane tanılı kız olgu, yüksek ateş ve idrar bulanıklığı ile başvurmuş; geçmişinde miyelomeningosel operasyonu ve hidrosefali nedeniyle ventriküler drenaj öyküsü saptanmıştır. Yapılan tetkiklerde iki taraflı hidronefroz, üreteral dilatasyon, mesane duvarında kalınlaşma ile akut böbrek hasarı bulguları saptanmış ve idrar kültüründe Acinetobacter baumannii üremesi üzerine kolistin tedavisine başlanmıştır. Takibinin üçüncü gününde göbek çevresinde pürülan akıntı, kızarıklık ve ülseröz lezyon gelişmiştir. Yapılan sistogram ve batın BT görüntülemelerinde, kontrast maddenin retroperitoneal alana sızdığı görülmüş ve mesane ile göbek arasında sinüs traktı saptanarak "enfekte urakal kanal artığı ve sekonder retroperitoneal mesane rüptürü" tanısı konmuştur. Hastada gelişen bu rüptüre, nörojen mesaneye bağlı yüksek intravezikal basınç ile enfekte urakal kalıntının zemin hazırladığı düşünülmüştür. Tedavi amacıyla enfeksiyon kaynaklı subkutan inflamasyon nedeniyle urakal kanal kalıntısı cerrahi olarak eksize edilmiş ve üst üriner sistemi yüksek mesane basıncından korumak için hastaya vezikostomi açılmıştır. Komplikasyonsuz tamamlanan operasyonlar ve antibiyoterapinin ardından olgu şifa ile taburcu edilmiştir.
A 5-year-old female case diagnosed with neurogenic bladder presented with high fever and cloudy urine, having a medical history of myelomeningocele surgery and ventricular drainage due to hydrocephalus. Examinations revealed bilateral hydronephrosis, ureteral dilatation, bladder wall thickening, and acute kidney injury, and colistin treatment was initiated after Acinetobacter baumannii grew in the urine culture. On the third day of follow-up, purulent discharge, redness, and an ulcerative lesion developed around the umbilicus. Cystogram and abdominal CT imaging showed contrast medium leaking into the retroperitoneal space and a sinus tract between the bladder and the umbilicus, leading to the diagnosis of "infected urachal remnant and secondary retroperitoneal bladder rupture". It was considered that high intravesical pressure due to neurogenic bladder and the infected urachal remnant predisposed the patient to this rupture. For treatment, the urachal remnant was surgically excised due to infection-induced subcutaneous inflammation, and a vesicostomy was performed to protect the upper urinary tract from high bladder pressure. Following uncomplicated surgeries and completed antibiotic therapy, the patient was discharged in good health.
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