Spontaneous bladder perforation in paraplegia as a late complication of augmentation enterocystoplasty: case report

An unusual cause of abdominal distension: intraperitoneal bladder perforation secondary to intermittent self-catheterisation

We report a strikingly unusual case of traumatic intraperitoneal perforation of an augmented bladder from clean intermittent self-catheterisation (CISC), which presented a unique diagnostic challenge. This case describes a 48-year-old T1 level paraplegic, who had undergone clamshell ileocystoplasty for detrusor overactivity, presenting with abdominal distension, vomiting and diarrhoea. Initial investigations were suggestive of disseminated peritoneal malignancy with ascitic fluid collections, but the ascitic fluid was found to be intraperitoneal urine from a perforation of the urinary bladder. This was associated with an inflammatory response in the surrounding structures causing an appearance of colonic thickening and omental disease. Although the diagnostic process was complex due to this patient's medical history, the treatment plan initiated was non-operative, with insertion of an indwelling urinary catheter and radiologically guided drainage of pelvic and abdominal collections. Overdistension perforations of augmented urinary bladders have been reported, but few have described perforation from CISC.

Urosepsis complicated by a spontaneous bladder perforation

The authors present a case of a 72-year-old diabetic male s/p pelvic irradiation for prostate carcinoma who arrived in the emergency department with complaints of shaking chills. After admission for urosepsis, he developed severe abdominal pain and examination revealed a diffusely tender abdomen. The patient was diagnosed with spontaneous urinary bladder perforation and underwent surgery. After several weeks of intravenous antibiotics, he was discharged with multiple drains in place and bilateral nephrostomy tubes.

Continent urinary diversion in childhood: complications of alcohol abuse developing in adulthood

PURPOSE

We reviewed the urological sequelae of alcohol abuse in patients following enterocystoplasty in childhood.

MATERIALS AND METHODS

We reviewed our patient registry of 385 enteric bladder augmentations. We evaluated patients providing information regarding social habits. Patients were defined as abusing alcohol if they consumed more than 2 alcoholic beverages daily and were compared to a control group consuming 0 to 2 alcoholic beverages daily.

RESULTS

A total of 203 patients met inclusion criteria. Of the patients 24 (12%) admitted a history of alcohol abuse, of whom 5 (21%) sustained a total of 10 bladder ruptures, all related to alcohol consumption. All 5 patients presented in a delayed fashion, at more than 12 hours to 5 days following rupture. Despite immediate exploration and repair, 3 separate cardiac resuscitations were performed in 2 patients, of whom 1 died. One patient underwent conversion to an ileal conduit for repeated bladder ruptures (4 episodes) and failure to remain sober following 2 rehabilitation treatments. Three patients maintained long-term sobriety (5 to 9 years) after rehabilitation treatments.

CONCLUSIONS

The incidence of alcohol abuse in patients following enterocystoplasty is 12% (24 of 203) and is not different from the reported lifetime risk of 12% to 18% seen in the United States population. Due to the severe consequences of alcohol abuse in patients with enterocystoplasty, we preoperatively instruct all patients that they will have to limit alcohol consumption following the operation and screen via a social history on subsequent followup visits. If a history of alcohol abuse is noted, immediate consultation for rehabilitation is provided.

[Spontaneous urinary bladder perforation after pediatric cystoplasty]

OBJECTIVE

The spontaneous cystoplasty perforation is a serious and potentially fatal problem if a delay in diagnosis and treatment occurs. We pretend: 1) to look for prevention analyzing the risk factors, 2) to identify the main data of diagnostic suspicion and 3) to evaluate the result of the treatments done.

MATERIAL AND METHODS

Out of 30 children with cystoplasty 5 of them have presented 8 perforations (16,6%). Several influential factors, the symptoms, the treatments and the evolution are reviewed.

RESULTS

The average time between cystoplasty and the perforation was 8,2 years. A urethral resistance that allows continence, and an insufficient intermittent catheterization, have been the main risk factors. In the 8 episodes there were abdominal pain and distension. The ultrasonography showed intraperitoneal extravasation in 5 episodes, multiple peritoneal cysts in one, and suggestive image of appendicular plastron in another one. The cystography showed intraperitoneal extravasation only in 3 cases. The initial management was conservative in the 7 episodes diagnosed before surgery, and 3 had a good evolution (42,8%); the other 4 needed surgery with good evolution in all cases. Two of 5 patients (40%) presented 3 relapses in an average time of 5 years. The survival is 100%.

CONCLUSIONS

16,6% of patients with cystoplasty of this series had one or more episodes of spontaneous bladder perforation. The more significant risk factors are a high urethral resistance and an inadequate intermittent catheterization. The patients with cystoplasty, and their families, must know this complication, their risk factors and symptoms to prevent it, or to facilitate an early diagnosis.