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Kapisiz A, Karabulut R, Kaya C, Eryilmaz S, Turkyilmaz Z, Atan A, Sonmez K. Our Cases and Literature Review for Presence of Bladder Hernias in the Inguinal Region in Children. Diagnostics (Basel) 2023; 13:diagnostics13091533. [PMID: 37174924 PMCID: PMC10177823 DOI: 10.3390/diagnostics13091533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The rate of bladder injury during inguinal hernia repair in children is not well known. However, it is known that bladder injury during childhood inguinal hernia repair places a serious morbidity burden on children. We sought to determine an algorithm to avoid accidental bladder injuries. METHODS Reports that included pediatric patients with inguinal hernias containing the bladder were searched. Keywords and mesh term searches were conducted in the MEDLINE, Scopus, and Web of Science databases. We reviewed our clinical records and found that two patients had inguinal hernias containing the bladder. RESULTS Nineteen articles reporting on 26 patients diagnosed with the presence of the bladder within the inguinal canal from 1962 to 2021 were included in this article. Our two patients were added to this group. Diagnoses were made incidentally during genitourinary radiological examinations (n = 3), intraoperatively during hernia repair (n = 7), or due to clinical symptoms and findings (n = 18) after standard hernia repair. Bladder augmentation was required for three patients. CONCLUSIONS During the operation, if there is any suspicion regarding the presence of the bladder in the inguinal region, we suggest performing a preoperative cystogram to confirm the position of the bladder and its injury. We recommend that the sac should be opened and the contents inspected before performing transfixion during high ligation of the hernia sac.
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Affiliation(s)
- Alparslan Kapisiz
- Department of Pediatric Surgery, Faculty of Medicine, Gazi University, 06560 Ankara, Turkey
| | - Ramazan Karabulut
- Department of Pediatric Surgery, Faculty of Medicine, Gazi University, 06560 Ankara, Turkey
| | - Cem Kaya
- Department of Pediatric Surgery, Faculty of Medicine, Gazi University, 06560 Ankara, Turkey
| | - Sibel Eryilmaz
- Department of Pediatric Surgery, Faculty of Medicine, Gazi University, 06560 Ankara, Turkey
| | - Zafer Turkyilmaz
- Department of Pediatric Surgery, Faculty of Medicine, Gazi University, 06560 Ankara, Turkey
| | - Ali Atan
- Department of Urology, Faculty of Medicine, Gazi University, 06560 Ankara, Turkey
| | - Kaan Sonmez
- Department of Pediatric Surgery, Faculty of Medicine, Gazi University, 06560 Ankara, Turkey
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Gunadi, Oktavian A, Iskandar K, Vujira KA, Fauzi AR. Bladder injury in an incarcerated inguinal hernia in a pediatric patient. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Hori T, Yasukawa D. Fascinating history of groin hernias: Comprehensive recognition of anatomy, classic considerations for herniorrhaphy, and current controversies in hernioplasty. World J Methodol 2021; 11:160-186. [PMID: 34322367 PMCID: PMC8299909 DOI: 10.5662/wjm.v11.i4.160] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/02/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
Groin hernias include indirect inguinal, direct inguinal, femoral, obturator, and supravesical hernias. Here, we summarize historical turning points, anatomical recognition and surgical repairs. Groin hernias have a fascinating history in the fields of anatomy and surgery. The concept of tension-free repair is generally accepted among clinicians. Surgical repair with mesh is categorized as hernioplasty, while classic repair without mesh is considered herniorrhaphy. Although various surgical approaches have been developed, the surgical technique should be carefully chosen for each patient. Regarding as interesting history, crucial anatomy and important surgeries in the field of groin hernia, we here summarized them in detail, respectively. Points of debate are also reviewed; important points are shown using illustrations and schemas. We hope this systematic review is surgical guide for general surgeons including residents. Both a skillful technique and anatomical knowledge are indispensable for successful hernia surgery in the groin.
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Affiliation(s)
- Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
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Shibuya S, Imaizumi T, Yamada S, Yoshida S, Yamada S, Toba Y, Takahashi T, Miyazaki E. Comparison of surgical outcomes between laparoscopic percutaneous extracorporeal closure (LPEC) and open repair for pediatric inguinal hernia by propensity score methods and log-rank test analysis. Surg Endosc 2021; 36:941-950. [PMID: 33616732 DOI: 10.1007/s00464-021-08354-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 02/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite a number of studies comparing laparoscopic inguinal hernia repair (LH) and open herniorrhaphy (OH), the putative advantage of LH remains controversial due to a paucity of firm evidence. We hypothesized that LH has both advantages and disadvantages compared to OH and sought to clarify them by comprehensively analyzing the retrospective data using the combination of multiple statistical methods. METHODS Operative data for inguinal hernia during the period from February 1999 to December 2019 were examined. The patients were assigned into two groups according to the surgical procedure: laparoscopic percutaneous extraperitoneal closure (LPEC, n = 2410) and OH (n = 2038). Operative and anesthesia times and incidence of postoperative complications were evaluated using the propensity score methods and log-rank test. RESULTS In comparison with OH, operative time of LPEC was longer for unilateral repair (21.59 ± 8.1 min vs 18.01 ± 8.0 min; p < 0.001) and shorter for bilateral repairs (28.55 ± 10.1 min vs 33.23 ± 11.7 min; p < 0.001), while anesthesia times were longer for both unilateral repair (57.67 ± 10.1 min vs 40.62 ± 11.9 min; p < 0.001) and bilateral repairs (65.95 ± 12.5 min vs 56.35 ± 15.1 min; p < 0.001). LPEC significantly reduced the risk of metachronous contralateral hernia (MCLH) (0.52% vs 9.29%; p < 0.001), but the recurrence rate was higher (0.21% vs 0.04%; p = 0.002) than OH. Orchiectomy due to testicular atrophy or torsion was required in 3 cases of OH (0.19%), whereas it was not seen in LPEC. CONCLUSIONS LPEC had a less risk of MCLH and testicular complications but was associated with a higher recurrence rate and longer anesthesia time. Propensity scoring techniques can enhance the robustness of retrospective comparisons between groups over several years of data collection, which is frequently required in pediatric surgery studies.
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Affiliation(s)
- Soichi Shibuya
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan. .,Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan.
| | - Takaaki Imaizumi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Susumu Yamada
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Shiho Yoshida
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Shunsuke Yamada
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Yoshie Toba
- Department of Anesthesiology, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Toshiaki Takahashi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Eiji Miyazaki
- Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
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Duess JW, Schaller MC, Lacher M, Sorge I, Puri P, Gosemann JH. Accidental bladder injury during elective inguinal hernia repair: a preventable complication with high morbidity. Pediatr Surg Int 2020; 36:235-239. [PMID: 31602498 DOI: 10.1007/s00383-019-04554-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Bladder injury (BI) represents a rare complication of inguinal hernia surgery. Protrusions of the urinary bladder through the deep inguinal ring ("bladder ears") have been reported with an incidence of 9% in infants younger than 6 months of age and may be misinterpreted as the hernia sac. This literature review was designed to determine incidence and outcomes of bladder injuries during pediatric inguinal hernia repair. METHODS A literature review of the literature (1967-2017) was performed using the keywords "bladder ears", "inguinal hernia", "iatrogenic bladder injury" and "bladder hernia". Publications were reviewed for epidemiology, presentation and extent of injury, treatment and outcome. RESULTS Thirteen articles reporting on 30 cases of BI during inguinal hernia repair from 1967 to 2017 were included (19 boys, 2 girls, 9 unknown). Median age at herniotomy was 10.5 months (1 month-6 years). Out of 30 children, 14 (47%) experienced mild complications. Sixteen patients (53%) had severe complications after initial surgery and needed revisional surgery. Complications were noticed up to 4 years after the initial surgery. In 9 (56%) of the 16 severe cases, major damage to the bladder wall and impairment of bladder capacity occurred. In seven patients (44%), secondary closure was successful. In ten patients (63%), the bladder was partially resected, and in one child (6%), the entire bladder was removed. CONCLUSIONS The degree of accidental BI during inguinal hernia repair was severe in in the majority of reported cases in the literature. Surgeons should be aware of the high prevalence of "bladder ears" in infants to prevent injury to the urinary tract.
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Affiliation(s)
- Johannes W Duess
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany.,National Children's Research Centre, Our Lady's Children's Hospital, Dublin, Ireland.,School of Medicine and Medical Science and Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | | | - Martin Lacher
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Ina Sorge
- Department of Pediatric Radiology, University of Leipzig, Leipzig, Germany
| | - Prem Puri
- National Children's Research Centre, Our Lady's Children's Hospital, Dublin, Ireland.,School of Medicine and Medical Science and Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Jan-Hendrik Gosemann
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany. .,National Children's Research Centre, Our Lady's Children's Hospital, Dublin, Ireland.
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Tröbs RB, Yilmaz B, Roll C, Alrefai M. Direct bladder hernia after indirect hernia repair in extremely low birth weight babies: two case reports and a review of the literature. J Med Case Rep 2017; 11:15. [PMID: 28088918 PMCID: PMC5238521 DOI: 10.1186/s13256-016-1171-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 12/05/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Inguinal hernia repair is the most common surgical procedure in babies. Despite a meticulous technique, relapses may occur. The occurrence of a direct bladder wall hernia in relapses has never before been reported in the literature. CASE PRESENTATION Here, we report two cases of direct bladder herniation: a white baby boy born after 25 weeks of gestation and a white baby boy born after 26 weeks of gestation. Both of the formerly extremely low birth weight babies were affected after open bilateral hernia repair. Recurrent hernias developed on the right side, and direct bladder herniation was identified intraoperatively. In one case, laparoscopy was applied to identify a supravesical type of hernia. Immaturity and a difficult postnatal course might have contributed to hernia relapse in these cases. CONCLUSIONS Misinterpretation of bladder herniation might have disastrous consequences. Laparoscopy is a helpful tool in comparable cases.
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Affiliation(s)
- R B Tröbs
- Department of Pediatric Surgery, St. Mary's Hospital Herne, St. Elisabeth Group, Ruhr-University of Bochum, Widumer Str. 8, 44627, Herne, Germany.
| | - B Yilmaz
- Clinic of Surgery and Pediatric Surgery, Friedrich-Ebert-Str. 13, 33699, Bielefeld, Germany
| | - C Roll
- Center of Perinatology, Department of Neonatology and Pediatric Intensive Care, Vest Children's Hospital, University of Witten-Herdecke, Dr.-Friedrich-Steiner Str. 5, 45711, Datteln, Germany
| | - M Alrefai
- Department of Pediatric Surgery, St. Mary's Hospital Herne, St. Elisabeth Group, Ruhr-University of Bochum, Widumer Str. 8, 44627, Herne, Germany
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Kaefer M, Agarwal D, Misseri R, Whittam B, Hubert K, Szymanski K, Rink R, Cain MP. Treatment of contralateral hydrocele in neonatal testicular torsion: Is less more? J Pediatr Urol 2016; 12:306.e1-306.e4. [PMID: 26708803 DOI: 10.1016/j.jpurol.2015.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 07/18/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Treatment of neonatal testicular torsion has two objectives: salvage of the involved testicle (which is rarely achieved) and preservation of the contralateral gonad. The second goal universally involves contralateral testicular scrotal fixation to prevent the future occurrence of contralateral torsion. However, there is controversy with regards to management of a synchronous contralateral hydrocele. It has been our policy not to address the contralateral hydrocele through an inguinal incision to minimize potential injury to the spermatic cord. Our objective in this study was to determine whether the decision to manage a contralateral hydrocele in cases of neonatal testicular torsion solely through a scrotal approach is safe and effective. PATIENTS AND METHOD We reviewed all cases of neonatal testicular torsion occurring at our institution between the years 1999 and 2006. Age at presentation, physical examination, ultrasonographic and intraoperative findings were recorded. Patients were followed after initial surgical intervention to determine the likelihood of developing a subsequent hydrocele or hernia. RESULTS Thirty-seven patients were identified as presenting with neonatal torsion. Age of presentation averaged 3.5 days (range 1-14 days). Left-sided pathology was seen more commonly than the right, with a 25:12 distribution. All torsed testicles were nonviable. Twenty-two patients were noted to have a contralateral hydrocele at presentation. All hydroceles were opened through a scrotal approach at the time of contralateral scrotal fixation. No patient underwent an inguinal exploration to examine for a patent process vaginalis. None of the patients who presented with a hydrocele have developed a clinical hydrocele or hernia after an average 7.5 years (range 4.3-11.2) follow-up. CONCLUSION We have demonstrated that approaching a contralateral hydrocele in cases of neonatal testicular torsion solely through a scrotal incision is safe and effective. Inguinal exploration was not performed in our study and our long-term results demonstrate that such an approach would have brought no additional benefit. In avoiding an inguinal approach we did not subject our patients to unnecessary risk of testicular or vasal injury. Contralateral hydrocele is commonly seen in cases of neonatal testicular torsion. In our experience this is a condition of minimal clinical significance and does not warrant formal inguinal exploration for treatment. This conservative management strategy minimizes the potential of contralateral spermatic cord injury in the neonate. The aims of the study were met.
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Affiliation(s)
- Martin Kaefer
- Pediatric Urology, Riley Hospital for Children, Indianapolis, IN, USA.
| | - Deepak Agarwal
- Pediatric Urology, Riley Hospital for Children, Indianapolis, IN, USA
| | - Rosalia Misseri
- Pediatric Urology, Riley Hospital for Children, Indianapolis, IN, USA
| | - Benjamin Whittam
- Pediatric Urology, Riley Hospital for Children, Indianapolis, IN, USA
| | - Katherine Hubert
- Pediatric Urology, Riley Hospital for Children, Indianapolis, IN, USA
| | - Konrad Szymanski
- Pediatric Urology, Riley Hospital for Children, Indianapolis, IN, USA
| | - Richard Rink
- Pediatric Urology, Riley Hospital for Children, Indianapolis, IN, USA
| | - Mark P Cain
- Pediatric Urology, Riley Hospital for Children, Indianapolis, IN, USA
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Almarzouq A, Mahmoud AH, Ashebu SD, Kehinde EO. Vesical calculus formation on non-absorbable sutures used for open inguinal hernia repair. Int J Surg Case Rep 2014; 5:811-5. [PMID: 25308188 PMCID: PMC4245678 DOI: 10.1016/j.ijscr.2014.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 09/09/2014] [Indexed: 11/29/2022] Open
Abstract
Foreign bodies in the urinary bladder always act as a nidus for formation of a calculus. This was a rare case of bladder stones secondary to an iatrogenic injury to the bladder in the form of prolene stitches used to repair an inguinal hernia protruding into the bladder. The patient most likely had a full bladder at the time of hernia repair or the bladder was part of the contents of the hernia sac. This case illustrates the need to ensure that the bladder is empty prior to pelvic surgery and for surgeons to have a good understanding of inguinal anatomy to avoid injuring the contents of the hernia sac.
INTRODUCTION Iatrogenic injuries to the urogenital tract are rare, with the bladder being the organ most affected. We describe a case of a vesical calculus that formed on non-absorbable sutures that were used to repair an inguinal hernia. PRESENTATION OF CASE A 45-year-old male presented with frank haematuria and dysuria 2 years following an open left inguinal hernia repair. A CT urography showed a vesical calculus adherent to the left anterio-lateral wall of the bladder. Cystoscopy revealed that the calculus formed on non-absorbable sutures. Cystolapaxy was performed followed by cystoscopic excision of the sutures. The patient's post-operative course was uneventful. DISCUSSION Foreign bodies in the urinary bladder always act as a nidus for formation of a calculus. Iatrogenic bladder injuries are common during hernia repair. It is however rare for sutures used to repair an inguinal hernia to involve the urinary bladder wall. The patient most likely had a full bladder at the time of hernia repair or the bladder was part of the contents of the hernia sac. CONCLUSION This case illustrates the need to ensure that the bladder is empty prior to pelvic surgery and for surgeons to have a good understanding of inguinal anatomy to avoid injuring the contents of the hernia sac.
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Affiliation(s)
- Ahmad Almarzouq
- Department of Surgery, Division of Urology, Mubarak Al-Kabeer Hospital, Kuwait
| | - Akram H Mahmoud
- Department of Surgery, Division of Urology, Mubarak Al-Kabeer Hospital, Kuwait
| | | | - Elijah O Kehinde
- Department of Surgery, Division of Urology, Mubarak Al-Kabeer Hospital, Kuwait; Department of Surgery, Division of Urology, Faculty of Medicine, Kuwait University, Kuwait.
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Raherinantenaina F, Rambel AH, Rakotosamimanana J, Rajaonanahary TMA, Rajaonera T, Rakototiana FA, Hunald FA, Andriamanarivo ML, Rantomalala HYH, Rakoto Ratsimba HN. [Urinary ascites, uroperitoneum and urinary peritonitis in children: management of nine case reports in Madagascar]. Prog Urol 2013; 23:1004-11. [PMID: 24090786 DOI: 10.1016/j.purol.2013.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 04/10/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the frequency of urinary peritonitis in children and to highlight its terms of management in a country with limited resources. PATIENTS AND METHODS We retrospectively observed nine case reports of urinary peritonitis collected in surgical reanimation service at the CHU of Antananarivo, from 1st January 2009 to 31 December 2012. RESULTS Urinary peritonitis accounts 0.5% of all pediatric abdominal emergencies and 5% of pediatric urological emergencies collected in our service during study period. Three etiologies were traumatic bladder rupture, one bladder iatrogenic rupture, four secondary to obstructive uropathy and one other after cystolithotomy. We found a new case of posttraumatic transverse rupture of the bladder neck. Among obstructive uropathy observed, there were two cases of posterior urethral valves and two cases of ureteralpelvic junction obstruction. Clinical expression was dominated by fever, with abdominal distention and defense. In majority of cases, etiological diagnosis was made intraoperatively. The surgical treatment by laparotomy was performed under cover of systemic antibiotic therapy. Evolution was complicated with sepsis in three cases and acute renal failure in both cases. Surgical follow-up without complication were observed in four cases. A child has died to septic shock and multivisceral failure. CONCLUSION Unlike urinary ascites resulting a transperitoneal extravasation of urine, uroperitoneum was a fistula between adominal cavity and content of the urinary tract. Urinary ascites was a rare cause of peritonitis. In contrast, uroperitoneum caused peritonitis quickly. Urinary peritonitis was a rare entity but severe prognosis in children. In majority of cases, etiological diagnosis was made intraoperatively.
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Affiliation(s)
- F Raherinantenaina
- Unité de soins de formation et de recherche (USFR), service de chirurgie viscérale et vasculaire, CHU Joseph Ravoahangy Andrianavalona (CHU-JRA), BP 4150, Antananarivo, Madagascar.
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