Aghaways I, Bapir R, Hawrami TA, Thahir NM, Al Kadum Hassan MA, Salih Hassan KM. Conservative management of delayed presentation of intraperitoneal bladder rupture following caesarean delivery: A case report.
Int J Surg Case Rep 2019;
59:31-34. [PMID:
31102837 PMCID:
PMC6525288 DOI:
10.1016/j.ijscr.2019.04.050]
[Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/27/2019] [Revised: 04/04/2019] [Accepted: 04/22/2019] [Indexed: 11/30/2022] Open
Abstract
Bladder injury is an uncommon complication of cesarean delivery with an incidence ranging from 0.0016% to 0.94%.
Delayed blabber rupture post CD may present with urinary ascites and elevated serum creatinine mimicking acute kidney injury.
Cystography is the diagnostic imaging of choice with the reported accuracy of 85%–100%.
Surgical repair is the treatment of choice for intraperitoneal bladder injury.
Conservative management with intraperitoneal and urethral catheter may succeed in properly selected cases.
Introduction
Bladder injury is an uncommon complication of cesarean delivery (CD) with an incidence ranging from 0.0016% to 0.94%. The risk factors are emergency CDs, subsequent CDs, trial of normal delivery after CD and whether adhesions are present or not. The presentation is either immediate intraoperative event or delayed bladder rupture and urinary ascites.
Case presentation
A 35-year-old female presented with considerable abdominal distension, shortness of breath, oliguria, straining to void and elevated levels of blood urea and serum creatinine 11 days after an uneventful Caesarean delivery. Abdominal ultrasound showed marked ascites. Immediate resuscitation was done, a urethral catheter and percutaneous intraperitoneal pigtail catheter were inserted confirming urinary ascites. Next day cystoscopy was performed and revealed a perforation at the posterior wall of the bladder. She was kept on conservative treatment with adequate urine diversion through both urethral and intraperitoneal catheter. Her condition improved and responded well.
Discussion
To the best of our knowledge this presentation of delayed intraperitoneal bladder rupture post CD is the second case reported in literature. Although surgical repair is regarded as the treatment of choice for intraperitoneal bladder injury, conservative treatment may succeed in properly selected cases. Non-operative managements include indwelling transurethral Foley catheter alone, percutaneous peritoneal drain alone or combined Foley catheter and percutaneous peritoneal drain for complete urinary drainage.
Conclusion
Delayed urinary bladder rupture is a very rare complication of cesarean delivery. Non-operative treatment can be a viable alternative to surgical repair in carefully selected patients.
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