Blow out of a colocystoplasty loop owing to bladder neck obstruction

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

The management of spinal cord injured (SCI) patients with small capacity, noncompliant bladders has focused on the preservation of renal function and social continence. When conservative management is unsuccessful, surgical intervention may prove beneficial. Augmentation enterocystoplasty is a reliable method of achieving increased bladder capacity while decreasing intravesical filling pressure. Spontaneous bladder rupture is a rare complication of augmentation enterocystoplasty. Because the urine is often colonized with bacteria, bladder rupture may result in chemical and bacterial peritonitis, which is associated with a 25% mortality rate. SCI patients may not present with the classic signs of an acute abdomen. Early diagnosis is critical so that aggressive management may be instituted. The case of late spontaneous perforation of an augmentation enterocystoplasty in a 33-year-old man with T7 complete paraplegia is presented, and the literature discussing the etiology, diagnosis, management, and prevention of augmented bladder perforation is reviewed.

Spontaneous bladder rupture following augmentation enterocystoplasty

Spontaneous bladder rupture following enterocystoplasty has been reported recently. The etiology remains unclear but appears to be multifactorial. The common factors among the reported patients are a high outlet resistance with total urinary continence and the presence of an augmented, dysfunctional native bladder. This combination may result in the development of high intravesical pressures or increased wall tension through several mechanisms, including over-filling and active contraction in the bowel or detrusor. The presence of an abnormal detrusor may cause the wall tension to be unevenly distributed toward the bowel segment. Diagnosis requires a high degree of suspicion and prompt laparotomy with closure of the defect. Prevention depends on maintaining low bladder volumes and, thus, pressures.

Delayed bladder rupture after augmentation enterocystoplasty

Delayed bladder perforation with peritonitis following augmentation enterocystoplasty in children with spina bifida is a serious and potentially life-threatening complication. Our experience with 4 such cases is presented. All patients had spina bifida with a neuropathic bladder and they had undergone augmentation enterocystoplasty with a tubular colonic segment of large bowel as part of an undiversion procedure. All patients were being managed with intermittent self-catheterization. The interval from augmentation enterocystoplasty until presentation ranged from 6 months to 3 years. Diagnosis was delayed in all cases, including 3 in which cystogram studies were normal despite findings of extravasation of urine at exploration. In 1 patient generalized sepsis developed with the respiratory distress syndrome and, subsequently, she died.