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

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.

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

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.