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Patel J, Sasson A, Simpson WL, Wilck E. The anatomy and pathology of the space of Retzius. Clin Imaging 2024; 110:110137. [PMID: 38593675 DOI: 10.1016/j.clinimag.2024.110137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/12/2024] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
The space of Retzius is an important anatomic location for pathology. Pathology in the space of Retzius is more common than previously believed, especially as more cases are discovered with increased use of cross-sectional imaging. Knowledge of the anatomy of the Space of Retzius is crucial for identifying and distinguishing between benign and pathological findings. This paper uses several case examples to discuss benign etiologies, including normal tissue or a foreign body. The paper also demonstrates a case series with pathologic findings in the Space of Retzius under the broad categories of infection, neoplasm, hemorrhage, or urine extravasation. Understanding of the anatomy and these example cases can improve the diagnostic accuracy of radiologists.
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Affiliation(s)
- Janki Patel
- The Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America.
| | - Arielle Sasson
- The Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America
| | - William L Simpson
- The Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America
| | - Eric Wilck
- The Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America
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2
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Merga OT, Bayileyegn NS. Spontaneous bladder rupture after alcohol binge presenting as a rare cause of acute abdomen: A case report and review of literatures. Int J Surg Case Rep 2023; 111:108942. [PMID: 37820482 PMCID: PMC10570937 DOI: 10.1016/j.ijscr.2023.108942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Bladder rupture, or perforation, is the rupture of the urinary bladder, which is often clinically classified as intraperitoneal, extraperitoneal, or combined types. Spontaneous bladder perforation is an extremely rare event and constitutes less than 2 % of bladder ruptures. It is often associated with previous bladder manipulation, lower urinary tract obstruction, instrumentation, pelvic radiotherapy or surgery, inflammation, and malignancy. Blood work will demonstrate leukocytosis with left shift, hematuria on urinalysis, and an ascites to serum creatinine ratio of more than one, which is highly suggestive of bladder rupture. CASE PRESENTATION A 38-year-old male patient presented with abdominal pain for 8 h and loss of consciousness lasting 4 h. The patient was acutely sick-looking with borderline blood pressure of 90/60 mmHg, pulse rate of 120, and has alcoholic breath. With a diagnosis of viscus perforation, he was operated and there was a 1 × 1 cm bladder dome perforation, which looks fresh. The ruptured edge was refreshed and repaired in two layers. The patient has recovered well, discharged and was fine on subsequent follow-ups. CLINICAL DISCUSSION Bladder rupture commonly develops after blunt abdominal trauma, of which more than 60 % is extraperitoneal. Intraperitoneal bladder rupture constitutes only a small fraction of all cases of rupture. There are only a few reports of spontaneous bladder rupture in the scientific literature. The risk of bladder rupture may be increased in the alcohol-impaired patient owing to decreased bladder filling sensation and abnormal behavioral responses. CONCLUSION Bladder rupture is a rare diagnosis in surgical patients, and spontaneous rupture is by far a very rare finding. The diagnosis of bladder perforation is often overlooked preoperatively for the obvious reason of its rarity and non-specific presentation. Early identification and timely management decrease mortality.
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Osman Y, Elawdy M, Taha DE, Zahran MH, Abouelkheir RT, Sharaf DE, Mosbah A, Ali-El Dein B. Bladder perforation as a complication of transurethral resection of bladder tumors: the predictors, management, and its impact in a series of 1570 at a tertiary urology institute. Int Urol Nephrol 2023; 55:2161-2167. [PMID: 37318699 PMCID: PMC10406724 DOI: 10.1007/s11255-023-03638-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/12/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To report the incidence, predictors, the impact of bladder perforation (BP), and our protocol of management in patients who underwent trans-urethral resection of bladder tumor (TURBT). METHODS This is a retrospective study, between 2006 and 2020, on patients who underwent TURBT for non-muscle-invasive bladder cancer (NMIBC). Bladder perforation was defined as any full thickness resection of the bladder wall. Bladder perforations were managed based on their severity and type. Small BP with no or mild symptoms were managed with prolongation of urethral catheters. Those with significant extraperitoneal extravasations were managed by insertion of a tube drain (TD). Abdominal exploration was done for extensive BP and all intraperitoneal extravasations. RESULTS Our study included 1,570 patients, the mean age was 58 ± 11 years and 86% were males. Bladder perforation was recorded in 10% (n = 158) of the patients. The perforation was extraperitoneal in 95%, and in 86%, the perforation was associated with no symptoms, mild symptoms, or mild fluid extravasation that required only prolongation of the urethral catheter. On the other hand, active intervention was required for the 21 remaining patients (14%) with TD being the most frequent management. History of previous TURBT (p = 0.001) and obturator jerk (p = 0.0001) were the only predictors for BP. CONCLUSIONS The overall incidence of bladder perforation is 10%; however, 86% required only prolongation of urethral catheter. Bladder perforation did not affect the probability for tumor recurrence, tumor progression nor radical cystectomy.
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Affiliation(s)
- Yasser Osman
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohamed Elawdy
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
- Urology Department, Sohar Hospital, Ministry of Health, Sohar, Oman
| | - Diaa-Eldin Taha
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
- Urology Departement, Faculty of Medicine, Kafr El-Sheikh University, Kafr El-Sheikh, Egypt
| | - Mohamed H. Zahran
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Rasha T. Abouelkheir
- Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Doaa Elsayed Sharaf
- Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Mosbah
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Bedeir Ali-El Dein
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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4
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Sturgess G, Lane G. Vesicocutaneous fistula presenting as a thigh abscess. Urol Case Rep 2022; 45:102261. [PMID: 36267344 DOI: 10.1016/j.eucr.2022.102261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/01/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
An abscess of the thigh may be a sign of tracking intra-abdominal pathology, often from the gastrointestinal tract. Less frequently this can arise from the bladder, usually after a history of surgical intervention, radiotherapy or pelvic trauma. This case describes a patient with a history of bladder cancer who developed a bladder perforation communicating with the thigh which presented as an abscess. Incision and drainage was atypical with clear, odourless fluid drained. CT scan and retrograde cystogram confirmed bladder perforation and vesicocutaneous fistula. They later developed a rectal perforation secondary to the pelvic urinoma.
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5
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Shi CX, Li ZX, Sun HT, Sun WQ, Ji Y, Jia SJ. Bladder perforation injury after percutaneous peritoneal dialysis catheterization: A case report. World J Clin Cases 2022; 10:7054-7059. [PMID: 36051131 PMCID: PMC9297435 DOI: 10.12998/wjcc.v10.i20.7054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/02/2022] [Accepted: 05/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Insertion of a catheter into the bladder is a rare complication of peritoneal dialysis (PD), and is mainly related to surgical injury. This paper reports a case of bladder perforation that was caused by percutaneous PD catheterization.
CASE SUMMARY A 64-year-old man underwent percutaneous PD catheterization for end-stage renal disease. On the second day after the operation, urgent urination and gross hematuria occurred. Urinalysis showed the presence of red and white blood cells. Empirical anti-infective treatment was given. On the third day after the operation, urgent urination occurred during PD perfusion. Ultrasound showed that the PD catheter was located in the bladder, and subsequent computed tomography (CT) showed that the PD catheter moved through the anterior wall into the bladder. The PD catheter was withdrawn from the bladder and catheterization was retained. Repeat CT on the fourth day after the operation showed that the PD catheter was removed from the bladder, but there was poor catheter function. The PD catheter was removed and the patient was changed to hemodialysis. CT cystography showed that the bladder healed well and the patient was discharged 14 d after the operation.
CONCLUSION Bladder perforation injury should be considered and treated timeously in case of bladder irritation during and after percutaneous PD catheterization. The use of Doppler ultrasound and other related technologies may reduce the incidence of such complications.
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Affiliation(s)
- Chun-Xia Shi
- Department of Nephrology, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing 101149, China
| | - Zhong-Xin Li
- Department of Nephrology, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing 101149, China
| | - Hai-Tao Sun
- Department of General Surgery, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing 101149, China
| | - Wu-Qing Sun
- Department of General Surgery, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing 101149, China
| | - Yu Ji
- Department of General Surgery, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing 101149, China
| | - Shu-Jing Jia
- Department of Medicine, Beijing Shuangqiao Hospital, Beijing 100121, China
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Singh V, Singh G, Singh MK. Xanthogranulomatous cystitis with malakoplakia leading to recurrent spontaneous bladder perforation in a young girl. Urol Case Rep 2022; 41:101984. [PMID: 35024341 PMCID: PMC8728461 DOI: 10.1016/j.eucr.2021.101984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/07/2021] [Accepted: 12/12/2021] [Indexed: 11/16/2022] Open
Abstract
Recurrent bladder perforation due to xanthogranulomatous cystitis with malakoplakia is rare entity and can lead to spontaneous bladder perforation. A 15 years girl presented with sudden pain abdomen with reduced urine output. Her exploratory laparotomy revealed, perforation of 2 cm at the dome of bladder with unhealthy margins. Excisional bladder biopsy and repair of bladder perforation by 3-0 polyglactin suture was done. The histopathology showed xanthogranulomatous cystitis with malakoplakia. Her records revealed the same histopathology in bladder perforation at age of 9 with lost follow-up till age of 15. Exploratory laparotomy and bladder repair should be done to save the patient.
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Affiliation(s)
- Vishwajeet Singh
- Department of Urology, King George's Medical University, Chowk, Lucknow, Uttar Pradesh, 226003, India
| | - Gyanendra Singh
- Department of Urology, King George's Medical University, Chowk, Lucknow, Uttar Pradesh, 226003, India
| | - Mukul Kumar Singh
- Department of Urology, King George's Medical University, Chowk, Lucknow, Uttar Pradesh, 226003, India
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Lee J, Suh J, Jeong CW, Kwak C, Kim HH, Ku JH. Efficacy of the Treatment of Intraperitoneal Bladder Perforation during Transurethral Resection of Bladder Tumor with the Urethral Catheter Alone: Retrospective Analysis of over 15 Years Using the Clinical Data Warehouse System. Urol Int 2021; 106:138-146. [PMID: 34350882 DOI: 10.1159/000517332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/09/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We investigated the efficacy of a urethral catheter alone for intraperitoneal perforation during transurethral resection of bladder tumor (TURBT). PATIENTS AND METHODS We retrospectively evaluated the medical records of 4,543 patients who underwent TURBT from January 2000 to December 2017 using the Clinical Data Warehouse system. The clinicopathologic characteristics, recurrence-free survival, and progression-free survival were compared between the patient groups with intraperitoneal perforation treated with the Foley catheter alone, extraperitoneal perforation, and matched control TURBT. RESULTS Intraperitoneal perforation and extraperitoneal perforation were observed in 16 (35.6%) and 29 (64.4%) patients, respectively. In the intraperitoneal perforation group, 11 (68.8%), 2 (12.5%), and 3 (18.8%) patients were treated with the Foley catheter alone, additional percutaneous drainage, and delayed open surgery, respectively. The use of the Foley catheter alone in patients with intraperitoneal perforation of smaller size than the cystoscope or no pelvic radiotherapy history showed improved efficacy without sequelae or therapeutic delay. One of the 2 patients with the size of the intraperitoneal perforation larger than the cystoscope was successfully treated with the Foley catheter alone, whereas the other patient underwent delayed surgical repair. There was no difference in recurrence-free survival and progression-free survival of the intraperitoneal perforation treated with the Foley catheter alone compared to those of the matched control TURBT (p = 0.909, p = 0.518) and the extraperitoneal perforation (p = 0.458, p = 0.699). CONCLUSIONS Intraperitoneal perforation rarely occurred during TURBT. In the case of intraperitoneal perforation of size smaller than cystoscopy or without pelvic radiotherapy history, treatment with the Foley alone showed successful improvement and safe oncological results. Therefore, treatment with the urethral catheter alone can be carefully considered when an intraperitoneal perforation smaller than the cystoscope size or without pelvic radiotherapy history occurs.
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Affiliation(s)
- Junghoon Lee
- Department of Urology, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jungyo Suh
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
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8
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Velhal RC, Jibhakate NA, Patwardhan SK, Patil BP. A case report of emphysematous cystitis with spontaneous intraperitoneal bladder perforation in an operated case of prolapsed intervertebral disc. Urol Ann 2021; 13:183-185. [PMID: 34194149 PMCID: PMC8210728 DOI: 10.4103/ua.ua_60_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 01/05/2021] [Indexed: 11/17/2022] Open
Abstract
This is a case report of emphysematous cystitis with spontaneous intraperitoneal bladder perforation in postoperative period of pedicle fixation surgery for prolapse intervertebral disc (L3–L4). The patient developed urinary retention with overflow incontinence with abdominal tenderness and fever 3 days after orthopedic procedure which on computed tomography (CT) scan found to have abundant air in urinary bladder with multiple air foci in bladder wall with suspected leak into intraperitoneal pelvic cavity, proven only after CT cystogram.
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Affiliation(s)
- Rishikesh C Velhal
- Department of Urology, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
| | | | - Sujata K Patwardhan
- Department of Urology, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
| | - Bhushan P Patil
- Department of Urology, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
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9
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Bergeron E, Lewinshtein D, Bure L, Vallee C. Pneumoperitoneum and peritonitis secondary to perforation of an infected bladder. Int J Surg Case Rep 2021; 81:105783. [PMID: 33744799 PMCID: PMC7985413 DOI: 10.1016/j.ijscr.2021.105783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/13/2021] [Accepted: 03/13/2021] [Indexed: 11/26/2022] Open
Abstract
Spontaneous urinary bladder rupture is a rare complication of urosepsis. Co-occurrence of pneumoperitoneum with a bladder perforation is very rare. Surgical intervention is mandatory in most cases of bladder perforations.
Introduction and importance Spontaneous urinary bladder rupture is a rare complication of urosepsis. Its co-occurrence with pneumoperitoneum is even more unusual. Case presentation A 73-year-old patient presented with acute retention with mild lower abdominal pain and difficulty with urinary voiding and cystitis. He was treated with bladder catheter and antibiotics. After one month, he suddenly developed peritonitis and shock. Pneumoperitoneum was observed on a chest x-ray. An emergent laparotomy was performed and a perforation of the bladder secondary to necrosis of part of the wall was found and resected. The patient recovered satisfactorily after the surgical intervention. Clinical discussion Spontaneous bladder rupture is a life-threatening condition that could be missed. Surgical intervention is mandatory to rule out other more probable causes of peritonitis and to manage the bladder perforation itself. Conclusion Pneumoperitoneum is rarely secondary to a bladder perforation. Immediate surgical intervention is required in order to avoid delays in treating any intra-abdominal condition including a bladder wall perforation.
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Affiliation(s)
- Eric Bergeron
- Departments of Surgery, Charles LeMoyne Hospital, Greenfield Park, Canada.
| | - Daniel Lewinshtein
- Departments of Surgery, Charles LeMoyne Hospital, Greenfield Park, Canada
| | - Lionel Bure
- Medical Imaging, Charles LeMoyne Hospital, Greenfield Park, Canada
| | - Chantal Vallee
- Internal Medecine, Charles LeMoyne Hospital, Greenfield Park, Canada
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10
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Harada J, Takehara K, Watanabe J. Bladder perforation with rectal impalement injury: Usefulness of exploratory laparoscopy for excluding intraperitoneal perforation. Urol Case Rep 2021; 37:101622. [PMID: 33732622 DOI: 10.1016/j.eucr.2021.101622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 02/28/2021] [Indexed: 11/16/2022] Open
Abstract
A 24-year-old man presented with anal bleeding after accidentally falling on a table leg. Computed tomography showed free air in the bladder and around the rectum with a high-density area without intraperitoneal free air. The patient was suspected of having extraperitoneal bladder perforation with rectal impalement, and he underwent transanal rectal repair, colostomy, and urethral catheter placement after intraperitoneal bladder perforation was excluded by exploratory laparoscopy. Postoperative course was uneventful, and the urethral catheter was removed 19 days after surgery. Three months after the operation, colostomy reversal was performed, and the patient did not experience any complications.
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Affiliation(s)
- Junki Harada
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
| | - Kosuke Takehara
- Department of Urology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Junichi Watanabe
- Department of Urology, Nagasaki Harbor Medical Center, Nagasaki, Japan
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11
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Luu DT, Duc NM, My TT, Ly TT, Bang LV, Lenh BV. Extraperitoneal bladder perforation secondary to transurethral resection of bladder tumor. Radiol Case Rep 2021; 16:811-4. [PMID: 33552331 DOI: 10.1016/j.radcr.2021.01.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 11/21/2022] Open
Abstract
Transurethral resection of bladder tumor (TURBT) is one possible treatment approach for bladder tumors. Bladder wall perforation is one potential complication of TURBT. Signs of perforation include abdominal distension, the inability to distend the bladder, and the low retrieval of irrigation fluids. Peritonitis may occur if a perforation diagnosis is delayed. Early detection and diagnosis are crucial for the prevention of severe complications, such as peritonitis and sepsis. Here, we describe a case of a 69-year-old male with a bladder rupture secondary to TURBT.
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12
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Passarelli R, Elyaguov J, Fox C, Bergamaschi R, Matthews G. Combined intra- and extra-peritoneal bladder perforation following rectal impalement injury. Urol Case Rep 2020; 34:101489. [PMID: 33224733 PMCID: PMC7662846 DOI: 10.1016/j.eucr.2020.101489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/05/2020] [Indexed: 11/30/2022] Open
Abstract
A 62-year-old male presented with abdominal pain and hematuria following impalement of the rectum with a wooden foreign object. CT imaging showed air and fluid in the peritoneum prompting the patient to undergo abdominal exploration. An anterior rectal perforation was discovered along with dual bladder lacerations of the posterior wall and dome. The patient underwent a diverting colostomy and primary bladder repair. Post-operative course was uncomplicated and bladder repair was followed via cystograms with catheter removal 2 months post-operatively. Four months after the injury the patient underwent colostomy closure and remains with normal bladder and bowel function at 21-month follow-up.
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Affiliation(s)
- Rachel Passarelli
- Department of Urology, New York Medical College/Westchester Medical Center, 100 Woods Rd, Valhalla, NY, 10595, USA
| | - Jason Elyaguov
- Department of Urology, New York Medical College/Westchester Medical Center, 100 Woods Rd, Valhalla, NY, 10595, USA
| | - Cristina Fox
- Department of Urology, New York Medical College/Westchester Medical Center, 100 Woods Rd, Valhalla, NY, 10595, USA
| | - Roberto Bergamaschi
- Department of Surgery, New York Medical College/Westchester Medical Center, 100 Woods Rd, Valhalla, NY, 10595, USA
| | - Gerald Matthews
- Department of Urology, New York Medical College/Westchester Medical Center, 100 Woods Rd, Valhalla, NY, 10595, USA
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Waqar M, Moubasher A, Ameen T, Robinson D, Walker NF. Erosion of an intrauterine contraceptive device into the urinary bladder: A case report. Case Rep Womens Health 2020; 29:e00274. [PMID: 33312880 PMCID: PMC7720014 DOI: 10.1016/j.crwh.2020.e00274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/18/2020] [Accepted: 11/18/2020] [Indexed: 11/25/2022] Open
Abstract
Intrauterine contraceptive devices may rarely erode into the urinary bladder, usually shortly after insertion. This case report describes the presentation and management of a copper-bearing intrauterine device which had eroded into the bladder. The patient presented with dysuria, dyspareunia and groin pain. The device had been inserted 10 years previously following a termination of pregnancy. A bladder stone had formed on the arm of the T-shaped device. The calculus was successfully lasered transurethrally and the intrauterine device was removed transvaginally. A urinary catheter was left on free drainage for four weeks and a follow-up cystogram showed no leak. Most complications related to intrauterine devices occur within days or weeks of insertion but in this case the complications presented 10 years later.
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Affiliation(s)
- Muhammad Waqar
- Department of Urology, Kings College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Amr Moubasher
- Department of Urology, Kings College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Torath Ameen
- Department of Urology, Kings College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Dudley Robinson
- Department of Urogynaecology, Kings College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Nicholas Faure Walker
- Department of Urology, Kings College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
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14
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Iwatsu J, Watanuki M, Hayashi K, Yoshida S, Yano T, Hatori M, Hosaka M, Hagiwara Y, Itoi E. Bladder perforation by orthopedic implants 26 years after limb-sparing surgery for left proximal femoral chondrosarcoma: A case report. Int J Surg Case Rep 2020; 76:441-445. [PMID: 33207408 PMCID: PMC7586051 DOI: 10.1016/j.ijscr.2020.09.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/25/2020] [Indexed: 11/30/2022] Open
Abstract
A patient underwent limb-sparing surgery for left proximal femoral chondrosarcoma. Bladder perforation by staples occurred 26 years after limb-sparing surgery. No reports describe staple migration into the bladder after limb-sparing surgery. Bladder injury is possible in patients with urinary symptoms after pelvic surgery. Implant complications may occur even after a long postoperative period.
Introduction The need for implant use during orthopedic surgeries has been increasing. Accordingly, increased implant failures have been reported. However, bladder perforation remains a rare complication after orthopedic surgery. Although a few reports have described bladder perforation after total hip arthroplasty, no previous studies have reported the migration of staples into the bladder after limb-sparing surgery. Presentation of case A 65-year-old patient underwent limb-sparing surgery to remove a chondrosarcoma in the left proximal thigh. Twenty-six years after surgery, a staple that had been used to fix artificial ligaments to the pubis migrated to perforate the bladder, resulting in painful urination. The staple was removed, and her symptoms improved. Discussion In this case, bladder perforation by the staple resulted in painful urination. The bladder perforation was not detected until 26 years after the initial surgery. Conclusion Our observations emphasize that implant complications may occur even after a long postoperative period, and the possibility of delayed bladder perforation from previous pelvic surgeries should be considered in patients presenting with urinary tract symptoms.
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Affiliation(s)
- Jun Iwatsu
- Department of Orthopedic Surgery, JR Sendai Hospital, 1-1-5 Itsutsubashi, Aoba-ku, Sendai, Japan
| | - Munenori Watanuki
- Department of Orthopedic Surgery, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Japan.
| | - Kouu Hayashi
- Department of Orthopedic Surgery, Senen Rihu Hospital, 2-2-108, Rihu-cho, Miyagi-gun, Japan
| | - Shinichirou Yoshida
- Department of Orthopedic Surgery, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Japan
| | - Toshihisa Yano
- Department of Orthopedic Surgery, Tome City Hospital, 25 Hasama-cho, Tome, Japan
| | - Masahito Hatori
- Department of Orthopedic Surgery, Tohoku Kosai Hospital, 2-3-11 Kokubun-cho, Aoba-ku, Sendai, Japan
| | - Masami Hosaka
- Department of Orthopedic Surgery, Miyagi Cancer Center, 47-1 Medeshimaazanodayama, Natori, Japan
| | - Yoshihiro Hagiwara
- Department of Orthopedic Surgery, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Japan
| | - Eiji Itoi
- Department of Orthopedic Surgery, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Japan
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15
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Ibrahimi A, Ziani I, El Boukili El Makhoukhi Z, El Sayegh H, Benslimane L, Nouini Y. Transurethral resection syndrome: A rare complication of intraperitoneal bladder perforation during transurethral resection of bladder tumor. Urol Case Rep 2020; 34:101465. [PMID: 33145173 PMCID: PMC7591725 DOI: 10.1016/j.eucr.2020.101465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 10/20/2020] [Accepted: 10/24/2020] [Indexed: 11/18/2022] Open
Abstract
Transurethral resection (TUR) syndrome is a rare and serious complication of bladder perforation during transurethral resection of bladder tumor (TURBT), secondary to the excessive absorption of electrolytes-free irrigating fluid by extravascular route. Its defined as the combination of clinical cardiovascular and/or neurological manifestations, along with hyponatremia. Herein we report a rare case of 61-year-old patient, who presented a typical and severe TUR syndrome, secondary to intraperitoneal bladder perforation during TURBT, requiring intubation and positive inotropic drugs in the intensive care unit (ICU), and which was successfully managed conservatively. The patient was discharged from the hospital without any complications.
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16
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Wu B, Wang J, Chen XJ, Zhou ZC, Zhu MY, Shen YY, Zhong ZX. Bladder perforation caused by long-term catheterization misdiagnosed as digestive tract perforation: A case report. World J Clin Cases 2020; 8:4993-4998. [PMID: 33195672 PMCID: PMC7642559 DOI: 10.12998/wjcc.v8.i20.4993] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/10/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Spontaneous bladder rupture is relatively rare, and common causes of spontaneous bladder rupture include bladder diverticulum, neurogenic bladder dysfunction, gonorrhea infection, pelvic radiotherapy, etc. Urinary bladder perforation caused by urinary catheterization mostly occurs during the intubation process.
CASE SUMMARY Here, we describe an 83-year-old male who was admitted with 26 h of middle and upper abdominal pain and a history of long-term catheterization. Physical examination and computed tomography of the abdomen supported the diagnosis of diffuse peritonitis, most likely from a perforated digestive tract organ. Laparoscopic exploration revealed a possible digestive tract perforation. Finally, a perforation of approximately 5 mm in diameter was found in the bladder wall during laparotomy. After reviewing the patient’s previous medical records, we found that 1 year prior the patient underwent an ultrasound examination showing that the end of the catheter was embedded into the mucosal layer of the bladder. Therefore, the bladder perforation in this patient may have been caused by the chronic compression of the urinary catheter against the bladder wall.
CONCLUSION For patients with long-term indwelling catheters, there is a possibility of bladder perforation, which needs to be dealt with quickly.
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Affiliation(s)
- Bin Wu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Jing Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Xu-Jian Chen
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Zhong-Cheng Zhou
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Ming-Yuan Zhu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Yi-Yu Shen
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Zheng-Xiang Zhong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
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17
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Schaer GN, Moeltgen T, Ryu G, Magg H, Khan Z, Sarlos D. A novel combined transurethral and suprapubic approach for excision of mesh at the bladder neck. Int Urogynecol J 2019; 31:663-665. [PMID: 31654095 DOI: 10.1007/s00192-019-04110-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/28/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Unrecognized bladder perforation of a tension-free sling is a rare situation. Removal of the intravesical sling has been done by laparotomy or transurethrally. With technique presented here we want to show a minimally invasive approach that allows complete removal of the intraluminal sling material, located at the bladder neck. METHODS This video shows a novel combined transurethral and suprapubic approach for radical removal of the mesh. Two 3.5-mm trocars were placed suprapubically into a filled bladder. One site was used for an optic with camera and the other for a 3.5-mm grasping forceps to apply tension on the mesh to pull it out of the bladder wall while it was being excised transurethrally with a cystoscope and transurethral scissors. RESULTS The patient's postoperative course was uneventful. At 1-month follow-up, the patient was free of dysuria and cystoscopy revealed complete healing of the mesh site. Because of recurrent stress urinary incontinence, another continence sling surgery has been performed (TVT exact). After a follow-up of 2 years, she is continent and free of dysuria. CONCLUSIONS This novel technique provides an effective means of removing mesh perforated into the bladder, located at the bladder neck, using a combined transurethral and suprapubic approach. The technique is minimally invasive and the applied traction allows complete removal of the intraluminal part of the mesh.
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Affiliation(s)
- Gabriel N Schaer
- Department of Obstetrics and Gynecology, Kantonsspital Aarau, 5001, Aarau, Switzerland.
| | | | - Gloria Ryu
- Department of Obstetrics and Gynecology, Kantonsspital Aarau, 5001, Aarau, Switzerland
| | - Heimo Magg
- Department of Obstetrics and Gynecology, Kantonsspital Aarau, 5001, Aarau, Switzerland
| | - Zaraq Khan
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Dimitri Sarlos
- Department of Obstetrics and Gynecology, Kantonsspital Aarau, 5001, Aarau, Switzerland
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18
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Mishra VV, Verneker RA, Lamba S. Bladder Perforation: A Missed Diagnosis Posttransobturator Tape. J Midlife Health 2019; 9:216-218. [PMID: 30692820 PMCID: PMC6332720 DOI: 10.4103/jmh.jmh_22_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The advent of transobturator tape (TOT) in 2001 reduced the risk of bladder perforation to 1% in TOT as compared to 5% in tension-free vaginal tape (TVT). We present a case of bladder perforation in TOT where the diagnosis was missed for 5 years. This patient presented with dysuria and dyspareunia repeatedly and was treated for repeated urinary tract infection. The mesh was excised by cystoscopy, following which the symptoms were relieved. Thus, bladder perforation through a rare complication of TOT should always be ruled out in patients presenting with the failure of surgery or irritable detrusor activity such as dysuria and urgency.
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Affiliation(s)
- Vineet V Mishra
- Department of Obstetrics and Gynaecology, Institute of Kidney Diseases and Research Centre, Ahmedabad, Gujarat, India
| | - Ruchika A Verneker
- Department of Obstetrics and Gynaecology, Institute of Kidney Diseases and Research Centre, Ahmedabad, Gujarat, India
| | - Sunita Lamba
- Department of Obstetrics and Gynaecology, Institute of Kidney Diseases and Research Centre, Ahmedabad, Gujarat, India
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19
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Milani R, Manodoro S, Cola A, Palmieri S, Frigerio M. Management of unrecognized bladder perforation following suburethral tape procedure. Int J Gynaecol Obstet 2018; 142:118-119. [PMID: 29574783 DOI: 10.1002/ijgo.12493] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 01/13/2018] [Accepted: 03/21/2018] [Indexed: 11/11/2022]
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20
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Konopitski A, Boniello A, Wang P, Shah M, Old A, Gingrich K. Intraoperative bladder perforation during primary total hip arthroplasty. Arthroplast Today 2017; 4:40-43. [PMID: 29560394 PMCID: PMC5859462 DOI: 10.1016/j.artd.2017.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 03/16/2017] [Accepted: 03/17/2017] [Indexed: 11/30/2022] Open
Abstract
We present a unique case of bladder perforation occurring intraoperatively during primary total hip arthroplasty. It is suspected that the patient's aberrant bladder anatomy, with idiopathic erosion of the quadrilateral space, predisposed the patient to bladder injury. Several preoperative risk factors for bladder injury were identified in the literature. These factors include cemented acetabular components, previous history of hip arthroplasty, history of pelvic trauma or intrapelvic surgery, and poor bone quality. Management of bladder injury, should it occur, includes bladder decompression with a Foley catheter, antibiotic administration, hemodynamic monitoring, and urology consult with close follow-up. This case reinforces the importance of urologic preoperative evaluation for anatomic variations of the bladder. In such cases, intraoperative Foley catheters to prevent distension may reduce the risk of perforation.
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Affiliation(s)
- Andrew Konopitski
- Department of Orthopaedics, Drexel University College of Medicine, Hahneman University Hospital, Philadelphia, PA, USA
| | - Anthony Boniello
- Department of Orthopaedics, Drexel University College of Medicine, Hahneman University Hospital, Philadelphia, PA, USA
| | - Patrick Wang
- Department of Orthopaedics, Drexel University College of Medicine, Hahneman University Hospital, Philadelphia, PA, USA
| | - Mitesh Shah
- Department of Orthopaedics, Drexel University College of Medicine, Hahneman University Hospital, Philadelphia, PA, USA
| | - Andrew Old
- Department of Orthopaedics, New York University Langone Medical Center/Insall Scott Kelly, Hospital for Joint Disease, New York, NY, USA
| | - Kevin Gingrich
- Department of Orthopaedics, Drexel University College of Medicine, Hahneman University Hospital, Philadelphia, PA, USA
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21
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Zachariou A, Kolynou A, Filiponi M. Rectal perforation: a rare complication of indwelling urethral catheterization. Hippokratia 2017; 21:58. [PMID: 29904261 PMCID: PMC5997023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- A Zachariou
- Urology Department, ELPIS Hospital, Volos, Greece
| | - A Kolynou
- Department of Microbiology, AHEPA University Hospital, Thessaloniki, Greece
| | - M Filiponi
- Department of Microbiology, ELPIS Hospital, Volos, Greece
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22
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23
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Vaidyanathan S, Singh G, Selmi F, Hughes PL, Soni BM, Oo T. Complications and salvage options after laser lithotripsy for a vesical calculus in a tetraplegic patient: a case report. Patient Saf Surg 2015; 9:3. [PMID: 25621008 PMCID: PMC4304632 DOI: 10.1186/s13037-014-0052-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/19/2014] [Indexed: 11/10/2022] Open
Abstract
Background Laser lithotripsy of vesical calculi in tetraplegic subjects with long-term urinary catheters is fraught with complications because of bladder wall oedema, infection, fragile urothelium, bladder spasms, and autonomic dysreflexia. Severe haematuria should be anticipated; failure to institute measures to minimise bleeding and prevent clot retention can be catastrophic. We present an illustrative case. Case presentation A tetraplegic patient underwent laser lithotripsy of vesical stone under general anaesthesia. During lithotripsy, severe bladder spasms and consequent rise in blood pressure occurred. Bleeding continued post-operatively resulting in clot retention. CT revealed clots within distended but intact bladder. Clots were sucked out and continuous bladder irrigation was commenced. Bleeding persisted; patient developed repeated clot retention. Cystoscopy was performed to remove clots. Patient developed abdominal distension. Bladder rupture was suspected; bed-side ultrasound scan revealed diffuse small bowel dilatation with mild peritoneal effusion; under-filled bladder containing small clot. Patient developed massive abdominal distension and ileus. Two days later, CT with oral positive contrast revealed intra-peritoneal haematoma at the dome of bladder with perforation at the site of haematoma. Free fluid was noted within the peritoneal cavity. This patient was managed by gastric drainage and intravenous fluids. Patient's condition improved gradually with urethral catheter drainage. Follow-up CT revealed resolution of bladder rupture, perivesical haematoma, and intra-peritoneal free fluid. Conclusion If bleeding occurs, bladder irrigation should be commenced immediately after surgery to prevent clot retention. When bladder rupture is suspected, CT of abdomen should be done instead of ultrasound scan, which may not reveal bladder perforation. It is debatable whether laparotomy and repair of bladder rupture is preferable to nonoperative management in tetraplegics. Anti-muscarinic drugs should be prescribed prior to lithotripsy to control bladder spasms; aspirin and ibuprofen should be omitted. If significant bleeding occurs during lithotripsy, procedure should be stopped and rescheduled. Percutaneous cystolithotripsy using a wide channel could be quicker to clear stones, as larger fragments could be retrieved; lesser stimulant for triggering autonomic dysreflexia, as it avoids urethral manipulation. But in patients with small, contracted bladder, and protuberant abdomen, percutaneous access to urinary bladder may be difficult and can result in injury to bowels.
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Affiliation(s)
- Subramanian Vaidyanathan
- Regional Spinal Injuries Centre, Southport and Formby District General Hospital, Town Lane, Southport, PR8 6PN UK
| | - Gurpreet Singh
- Department of Urology, Southport and Formby District General Hospital, Town Lane, Southport, PR8 6PN UK
| | - Fahed Selmi
- Regional Spinal Injuries Centre, Southport and Formby District General Hospital, Town Lane, Southport, PR8 6PN UK
| | - Peter L Hughes
- Department of Radiology, Southport and Formby District General Hospital, Town Lane, Southport, PR8 6PN UK
| | - Bakul M Soni
- Regional Spinal Injuries Centre, Southport and Formby District General Hospital, Town Lane, Southport, PR8 6PN UK
| | - Tun Oo
- Regional Spinal Injuries Centre, Southport and Formby District General Hospital, Town Lane, Southport, PR8 6PN UK
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Sakai NS, Acharya V, Mansour S, Saleemi MA, Cheslyn-Curtis S. An unusual cause of small bowel obstruction caused by a Richter's-type hernia into the urinary bladder. Int J Surg Case Rep 2014; 5:358-60. [PMID: 24858979 PMCID: PMC4064428 DOI: 10.1016/j.ijscr.2014.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 04/23/2014] [Accepted: 04/23/2014] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The authors present an unusual case of small bowel obstruction in a 62-year-old man. PRESENTATION OF CASE A 62-year-old man with a background of transitional cell carcinoma (TCC) of the bladder presented to the emergency department with abdominal pain, distension, vomiting and had not opened his bowels for three days. 3 weeks previously he had a repeat Transurtheral resection of bladder tumour (TURBT), during which there was an iatrogenic perforation of the bladder. A CT scan of the abdomen and pelvis revealed small bowel obstruction but did not identify a cause. At laparotomy the cause of the obstruction was identified as a section of the small bowel that had partially herniated into the bladder, via the perforation. The defect was repaired and the patient made an uneventful recovery. DISCUSSION Herniation of the bowel into a defect in the bladder wall is a rare event with only 6 previous cases reported in the literature. It can cause signs and symptoms of bowel obstruction. CONCLUSION In patients with known bladder perforations who present with symptoms and signs of bowel obstruction, bowel herniation into the bladder should be considered. Early surgical intervention may be necessary if the patient is clinically unwell with appropriate symptoms and signs and imaging does not provide conclusive answer.
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Affiliation(s)
- Naomi S Sakai
- Luton and Dunstable University Hospital, Lewsey Road, Luton LU4 0DZ, United Kingdom.
| | - Vikas Acharya
- Luton and Dunstable University Hospital, Lewsey Road, Luton LU4 0DZ, United Kingdom.
| | - Sami Mansour
- Luton and Dunstable University Hospital, Lewsey Road, Luton LU4 0DZ, United Kingdom.
| | - Mohammed A Saleemi
- Luton and Dunstable University Hospital, Lewsey Road, Luton LU4 0DZ, United Kingdom.
| | - Sarah Cheslyn-Curtis
- Luton and Dunstable University Hospital, Lewsey Road, Luton LU4 0DZ, United Kingdom.
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25
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Benjelloun EB, Ahallal Y, Khatala K, Souiki T, Kamaoui I, Taleb KA. Rectal impalement with bladder perforation: A review from a single institution. Urol Ann 2013; 5:249-54. [PMID: 24311904 PMCID: PMC3835982 DOI: 10.4103/0974-7796.120298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 10/16/2012] [Indexed: 12/02/2022] Open
Abstract
Context: Impalement injuries of the rectum with bladder perforation have been rarely reported. Such lesions have been associated with increased postoperative morbidity. A well-conducted preoperative evaluation of the lesions tends to prevent such complications. Aims: To increase awareness about patients with rectal impalement that involve bladder injuries and to examine the significance of thorough clinical examination and complementary investigation for these patients’ management. Materials and Methods: Retrospectively, we identified three patients with rectal impalement and bladder perforation treated in University Hospital Hassan II, Fez, Morocco. We recorded the symptoms, subsequent management, and further follow-up for each patient. All available variables of published cases were reviewed and analyzed. Results: Evident urologic symptoms were present in only one patient. Bladder perforation was suspected in two other patients on the basis of anterior rectal perforation in digital exam. Retrograde uroscanner could definitely confirm the diagnosis of bladder perforation. Fecal and urine diversion was the basis of the treatment. No postoperative complications were noted. We have reviewed 14 previous reports. They are presented mainly with urine drainage through the rectum. Radiologic investigation (retrograde cystography and retrograde uroscanner) confirmed bladder perforation in 10 patients (71.4%). Unnecessary laparotomy was performed in six patients (42.8%). Fecal diversion and urinary bladder decompression using urethral catheter were the most performed procedures in bladder perforation [6/14 patients (42.8%)]. No specific postoperative complications were reported. Conclusions: A high index of clinical suspicion is required to make the diagnosis of bladder perforation while assessing patients presenting with rectal impalement. Meticulous preoperative assessment is the clue of successful management.
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26
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May F, Schlenker B, Hofer B, Stief CG, Rau HG. Laparoscopic repair of iatrogenic bladder perforation during transurethral bladder tumor resection: Case report and literature review. Indian J Urol 2013; 29:61-3. [PMID: 23671369 PMCID: PMC3649604 DOI: 10.4103/0970-1591.109988] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
An intraperitoneal bladder perforation occurred during transurethral tumor resection under general anesthesia in a 82 year old woman. The bladder was repaired with a laparoscopic closure and an indwelling urethral catheter. The histopathology revealed T1 high grade urothelial carcinoma. The patient recovered well and was discharged home on postoperative day 7. This case highlights the successful use of laparoscopy in the treatment of a rare urological complication.
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Affiliation(s)
- Florian May
- Department of Urology, Amper-Klinikum, Dachau, Germany ; Department of Urology, Ludwig Maximilians-University, Munich, Germany
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