Panperitonitis caused by gangrene of the urinary bladder: report of a successfully treated case

The patient was a 74-year-old woman with Parkinson's disease who had a past history of total hysterectomy for uterine myoma. She was admitted for a femoral neck fracture and treated conservatively. From the third day of the illness, the patient experienced increased urinary frequency and constant urge to urinate. On the seventh day, the patient developed peritonitis and underwent emergency surgery. Laparotomy confirmed a dark greenish malodorous abscess in the abdominal cavity. The bladder was necrotic and perforated, and the patient was accordingly diagnosed with panperitonitis caused by bladder gangrene. Because almost the entire bladder exhibited full-layer necrosis, it was determined that bladder preservation would not be possible, and total cystectomy, bilateral ureterocutaneostomy, and abdominal drainage were performed. Postoperatively, residual intra-abdominal abscess was present, but this resolved with drainage and antibiotic administration. Here, we present this patient who survived extremely rare panperitonitis caused by bladder gangrene.