Nonoperative treatment for intraperitoneal bladder rupture

Vaginal pessary: a culprit for intraperitoneal bladder perforation

Vaginal pessaries are widely considered to be a safe and effective non-surgical management option for women with pelvic organ prolapse. Complications may occur, and are more frequent with improper care and certain device designs and materials. It is imperative to provide information to patients about potential complications. We present the case of a woman in her 70s who presented to the Emergency Department with increasing groin and abdominal pain following a vaginal pessary insertion 2 days prior for grade 3 vaginal vault prolapse. On presentation, her abdomen was markedly distended with guarding. Laboratory investigations showed a significant acute kidney injury with a metabolic acidosis. An initial non-contrast CT showed fluid and inflammatory changes surrounding the bladder, and bladder perforation was suspected. A subsequent CT cystogram showed extravasation of contrast from the bladder into the peritoneal cavity, in keeping with an intraperitoneal bladder rupture. The patient underwent an emergency bladder repair in theatre.

Spontaneous rupture of the urinary bladder: A rare case report

Spontaneous rupture of the bladder (SRUB) is an extremely rare emergency that can be misdiagnosed due to its non-specific clinical presentation, leading to patient death. This study aimed to summarize SRUB's clinical features, diagnosis, and treatment through our case. We report a case of a 39-year-old female with preoperative peritonitis and peritoneal effusion diagnosis. We performed an emergency laparoscopic surgery and found she had a ruptured bladder. She was treated with laparoscopic rupture repair and suprapubic cystostomy. She recovered well, was discharged after seven days, and had the cystostomy tube removed after five weeks.

Endovascular Management of Extra-Peritoneal Hematoma Secondary to Bladder Catheterization

Bladder rupture related to Foley catheter insertion is a rare condition mainly reported in patients with chronic bladder disease. In the present case, this rare condition was associated with massive hematoma due to active arterial bleeding, which was treated by embolization. We present the case of a 38-year-old woman admitted to the gastroenterology department with decompensated alcoholic liver cirrhosis, anemia, malnutrition, and diabetes. Six days after admission, she presented with hypotension and tachycardia associated with gross hematuria. An abdominal computed tomography scan revealed a Foley catheterization-related bladder perforation and a massive extra-peritoneal hematoma caused by active arterial bleeding from a distal branch of the right vesical artery. A successful embolization was performed with microparticles and coiled with complete hemorrhage control on post-procedure imaging. The bladder perforation was treated conservatively with a urinary drainage catheter, irrigation, and antibiotics. Despite these measures, the patient died 15 days later due to liver failure and sepsis. Our case highlights that commonly performed simple procedures can lead to severe complications, especially in frail patients.

A nontraditional presentation and treatment for emphysematous cystitis

Emphysematous cystitis (EC) is a bladder pathology typically resulting from gas-producing bacterial infections. Risk factors include female gender, age greater than 60, diabetes mellitus, glycosuria, and urinary stasis. If not addressed promptly, it can progress to critical conditions. Management depends on severity, ranging from conservative to surgical interventions. We present a unique case of EC in a patient who lacked the most common risk factors, and who experienced a spontaneous intraperitoneal bladder rupture. Additionally, we treated this presentation against what historically is suggested. Lastly, this is the first published incidence of a patient with both Parkinson's Disease and EC.

Retrospective evaluation of the use of small-bore wire-guided catheters for the management of peritoneal effusion in cats and dogs

OBJECTIVE

To describe the use of small-bore wire-guided catheters in the management of peritoneal effusion in cats and dogs and to detail any associated adverse events.

DESIGN

Retrospective study.

SETTING

University teaching hospital ANIMALS: Forty-five client-owned animals that had peritoneal catheters placed for management of peritoneal effusion between July 2010 and June 2021.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Forty-five cases were included (25 dogs and 20 cats). Twenty-eight animals had the catheter placed to aid management of a uroabdomen, 8 of which recovered without surgical management, 11 had the catheter placed to allow autotransfusion of hemoabdomen, 3 had peritonitis, and 3 had ascites secondary to cardiac disease. Twenty-seven cases (15 dogs and 12 cats) received sedation (n = 24) or local anesthesia alone (n = 3) to facilitate catheter placement, and 6 cases had the catheter placed while under general anesthesia. Median length of catheter persistence was 24 hours (range: 2-144 h). The most common adverse events reported were impaired drainage (n = 7) and leakage at the insertion site (n = 4).

CONCLUSIONS

Peritoneal catheters can be inserted percutaneously for management of peritoneal effusion. Indications include stabilization and conservative management of uroabdomen, and autotransfusion. They can often be placed with minimal or no sedation and adverse events appear infrequent in occurrence.

Spontaneous Rupture of Urinary Bladder: Two Case Reports and Review of Literature

Objectives: Spontaneous rupture of the urinary bladder (SRUB) is extremely rare and might be misdiagnosed, leading to a high mortality rate. The current study aimed to identify the cause, clinical features, and diagnosis strategy of SRUB. Methodology: We presented a case report for two women (79 and 63 years old) misdiagnosed with acute abdomen and acute kidney injury, respectively, who were finally confirmed to have SRUB by a series of investigations and exploratory surgery. Meanwhile, literature from multiple databases was reviewed. PubMed, the Chinese National Knowledge Infrastructure (CNKI), the Chinese Biological Medical Literature Database (CBM), WANFANG DATA, and the Chongqing VIP database for Chinese Technical Periodicals (VIP) were searched with the keywords "spontaneous bladder rupture" or "spontaneous rupture of bladder" or "spontaneous rupture of urinary bladder." All statistical analyses were conducted using SPSS 20.0 software. Results: A total of 137 Chinese and 182 English literature papers were included in this article review. A total of 713 SRUB patients were analyzed, including the two patients reported by us. The most common cause of SRUB was alcohol intoxication, lower urinary tract obstruction, bladder tumor or inflammation, pregnancy-related causes, bladder dysfunction, pelvic radiotherapy, and history of bladder surgery or bladder diverticulum. Most cases were diagnosed by exploratory laparotomy and CT cystography. Patients with extraperitoneal rupture could present with abdominal pain, abdominal distention, dysuria, oliguria or anuria, and fever. While the main symptoms of intraperitoneal rupture patients could be various and non-specific. The common misdiagnoses include acute abdomen, inflammatory digestive disease, bladder tumor or inflammation, and renal failure. Most of the patients (84.57%) were treated by open surgical repair, and most of them were intraperitoneal rupture patients. Overall, 1.12% of patients were treated by laparoscopic surgery, and all of them were intraperitoneal rupture patients. Besides, 17 intraperitoneal rupture patients and 6 extraperitoneal rupture patients were treated by indwelling catheterization and antibiotic therapy. Nine patients died of delayed diagnosis and treatment. Conclusions: SRUB often presents with various and non-specific symptoms, which results in misdiagnosis or delayed treatment. Medical staff noticing abdominal pain suggestive of peritonitis with urinary symptoms should be suspicious of bladder rupture, especially in patients with a history of bladder disease. CT cystography can be the best preoperative non-invasive examination tool for both diagnosis and evaluation. Conservative management in the form of urine drainage and antibiotic therapy can be used in patients without severe infection, bleeding, or major injury. Otherwise, surgical treatment is recommended. Early diagnosis and management of SRUB are crucial for an uneventful recovery.

A Complex Case of Emphysematous Cystitis in a Peritoneal Dialysis Patient

Emphysematous cystitis (EC) is a relatively rare condition characterized by gas formation in the bladder wall and/or lumen. We report a case of emphysematous cystitis with a bladder perforation in an 84-year-old male on peritoneal dialysis who presented with fever, dysuria, hematuria, and hypotension. Gas in the bladder wall, as well as a small perforation in the roof of the urinary bladder, was seen on the abdominal CT scan. The causative organism identified was Escherichia coli. The patient recovered with broad-spectrum antibiotics along with bladder irrigation and drainage. After initial bladder washouts, peritoneal dialysis was continued with close monitoring. Early antibiotic therapy and a conservative approach to the management of small intraperitoneal bladder perforations were effective in this patient. Peritoneal dialysis was uninterrupted for the duration of the admission and after discharge.

Non-Operative Management of Iatrogenic Intraperitoneal Bladder Injury Following a Cesarean Section

Iatrogenic bladder injuries with intraperitoneal extravasations are standardly managed surgically. However, we are presenting a case of iatrogenic intraperitoneal bladder injury developing after a cesarean section that was managed successfully by conservative therapy after tapping and pigtail drainage of 14 days. On the next follow up, which was 14 days later, there was a complete resolution with no signs of injury. Therefore, the trial of conservative approach may prove beneficial to minimize the chances of any invasive interventions in such cases.

Successful conservative management of a spontaneous intraperitoneal rupture of bladder diverticulum in a critical patient: A case report. A CARE-compliant article

RATIONALE

A spontaneous rupture of the bladder diverticulum in an adult patient is extremely rare. The recommended treatment is surgery. However, some cases can be successfully treated with urinary catheterization, antibiotics, and/or percutaneous peritoneal drainage. In this case report, a spontaneous rupture of the bladder diverticulum was successfully treated non-surgically because it was deemed too risky for surgical intervention, such as non-ST segment elevation myocardial infarction (NSTEMI).

PATIENT CONCERNS

A 76-year-old man presented with abdominal pain, distention, diarrhea, and oliguria for 3 days and hypotension for 1 day with no history of trauma. The patient showed direct and rebound tenderness in the lower abdomen. Computed tomography revealed an intraperitoneal bladder rupture associated with the bladder diverticula. Electrocardiography, echocardiography, and elevated cardiac enzyme suggested NSTEMI.

DIAGNOSES

A spontaneous rupture of the bladder diverticulum, NSTEMI, and suspected sepsis due to gastroenteritis or urinary infection.

INTERVENTIONS

The patient was treated conservatively with urinary catheterization and antibiotics for a bladder rupture and an infection. Percutaneous transluminal coronary angioplasty was performed for NSTEMI.

OUTCOMES

The patient fully recovered without complications on hospitalization day 13.

LESSONS

Conservative management might be an alternative for a spontaneous intraperitoneal bladder rupture in some cases. However, close observation is required, and surgical intervention is the first option for a spontaneous intraperitoneal rupture of the bladder diverticulum.

Intraperitoneal urinary bladder rupture diagnosed with ultrasound: An uncommon image

We present a case of intraperitoneal bladder rupture after fall. The patient presented with lower abdominal pain, difficulty to void urine, and mild hematuria. Catheterization revealed blood-tinged urine. Ultrasound showed a well-defined defect in the dome of bladder with flow of saline through the defect into the peritoneum, on flushing the Foley's catheter. On laparotomy, a 5 cm × 5 cm defect was found in the bladder dome that was repaired.

Conservative management of delayed presentation of intraperitoneal bladder rupture following caesarean delivery: A case report

•

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.

Successful Conservative Treatment of Traumatic Intraperitoneal Bladder Rupture in a Child: A Case Report

The urinary bladder is protected by the pelvic bones and hence is a site less susceptible to external force injury than other organs. As children’s bones are not fully developed, the risk of bladder injury by external force is greater in children than adults. Pelvic fractures often cause the bladder to rupture, as do strong external forces when the bladder is filled. Bladder rupture is categorized as extraperitoneal or intraperitoneal, and treatments differ between the two. Extraperitoneal injury usually heals after drainage alone, whereas intraperitoneal injury usually requires surgical intervention such as a combination of surgical repairs and drainage. Herein, we report a pediatric case of intraperitoneal bladder rupture successfully treated without surgical repair (i.e., with drainage via an intraperitoneal tube and a urethral catheter only). Our report suggests that nonoperative treatment is an option for pediatric patients with intraperitoneal bladder rupture if certain conditions are met.