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Distended bladder presenting with altered mental status and venous obstruction
Vaughan Washco1, Lee Engel1, David L Smith2
1Department of Internal Medicine, Louisiana State University Health Sciences Center, New Orleans, LA.
Ochsner Journal
|April 2, 2015
Summary
Acute bladder outflow obstruction in an elderly male caused bilateral leg swelling and altered mental status. Prompt Foley catheterization relieved symptoms, highlighting a rare cause of edema and confusion.
Area of Science:
- Internal Medicine
- Nephrology
- Cardiology
Background:
- Bilateral lower extremity edema often stems from venous congestion due to heart, liver, or kidney issues.
- Other causes include thromboembolism, lymphatic obstruction, or external venous compression.
Observation:
- An 83-year-old male with a history of hematologic malignancies and benign prostatic hypertrophy presented with altered mental status and new-onset bilateral lower extremity edema.
- Computed tomography revealed a distended bladder compressing the bilateral external iliac veins, indicating acute bladder outflow obstruction.
Findings:
- Urinary catheterization with a Foley catheter led to significant urine output.
- This intervention resulted in rapid improvement of lower extremity edema and mental status.
Implications:
- This case highlights acute bladder outflow obstruction as a reversible cause of bilateral lower extremity edema and altered mental status.
- The resolution of symptoms suggests the potential for "cystocerebral syndrome" in such cases, warranting consideration in differential diagnoses.
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