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A Case of Acute Aluminum Encephalopathy with Intraperitoneal Bladder Rupture Following Aluminum Bladder Irrigation in a Patient with Normal Renal Function

정상 신기능 환자에서 알루미늄 방광세척술 후 방광파열과 동반하여 발생한 급성 알루미늄 뇌증 1예

  • An, Young-Hwan (Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Kim, Sung-Gyun (Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Park, Ji-Young (Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Jang, Gil-Su (Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Kim, So-Yoen (Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Hong, Eun-Young (Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • An, Jung-Sun (Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine)
  • 안영환 (한림대학교 의과대학 한림대학교성심병원 신장내과) ;
  • 김성균 (한림대학교 의과대학 한림대학교성심병원 신장내과) ;
  • 박지영 (한림대학교 의과대학 한림대학교성심병원 신장내과) ;
  • 장길수 (한림대학교 의과대학 한림대학교성심병원 신장내과) ;
  • 김소연 (한림대학교 의과대학 한림대학교성심병원 신장내과) ;
  • 홍은영 (한림대학교 의과대학 한림대학교성심병원 신장내과) ;
  • 안정선 (한림대학교 의과대학 한림대학교성심병원 신장내과)
  • Published : 2012.08.01

Abstract

Acute aluminum intoxication is uncommon in clinical practice but can be fatal. Most cases have been reported in patients with decreased renal function, especially dialysis patients. We describe a case of acute aluminum encephalopathy with intraperitoneal bladder rupture following aluminum bladder irrigation in a patient with normal renal function. A 51-year-old woman with a radical hysterectomy and external irradiation therapy for cervical cancer 15 years earlier was admitted due to gross hematuria. An aluminum intravesical irrigation was performed. After 1 day of intravesical irrigation, abdominal pain and fever developed. Abdominal CT images demonstrated bladder perforation and peritonitis. An emergency laparotomy was performed. Operative findings showed a perforated dome of the bladder with gray colored peritoneal fluids. Two days after the operation, she complained of numbness and pain in the left side of her face. Acute aluminum encephalopathy was diagnosed after excluding infectious, rheumatological, and other vascular causes. She was treated with combined intravenous deferoxamine and hemodialysis.

알루미늄 중독 환자들은 대부분 신부전 환자에서 보고되고 있으며 치료 역시 데페록사민이나 혈액투석 등 신부전에서의 치료를 중심으로 한다. 저자들은 정상 신기능 성인 환자에게서 알루미늄 방광세척술 후 방광파열과 동반하여 발생한 급성 알루미늄 뇌증 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이며 신부전 환자가 아니더라도 방광파열등으로 다량의 알루미늄에 노출이 될 경우 혈중 알루미늄 수치가 급격히 상승할 위험성이 높기에 유의해야 할 것으로 생각된다.

Keywords

References

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