Lower abdominal phlegmon due to spontaneous rupture of an ileal neobladder

Guideline proposal for the conservative management of a ruptured neobladder

Level of evidence: 4

[Recurrent neobladder rupture: conservative management]

PURPOSE

To present a case of recurrent neobladder rupture treated in a conservative fashion. To review the articles on conservative management of cases like this one published from 1985.

RESULTS

Nineteen articles have been published since 1985 on spontaneous neobladder rupture, 4 of which describe the possibility of a successful conservative management, provided that the patients are carefully selected.

CONCLUSIONS

Faced to abdominal pain in patients with neobladder, it is essential to suspect spontaneous perforation and, if possible, to confirm such suspicions by means of cystography or CT. An exploratory laparotomy may be necessary in many instances, sometimes due to lack of a diagnosis and sometimes because the patient's status rules out any other procedure, but in selected and precisely diagnosed cases a conservative management can be resolvent.

Conservative management of spontaneous rupture of a sigmoid colon neobladder

A case of successful management of spontaneous perforation of an orthotopic sigmoid colon neobladder 18 months following radical cystectomy for muscle-invasive transitional cell carcinoma is described. Conservative management of such perforations has rarely been described in the literature; however, this is the first case report of sigmoid colon neobladder perforation and of its successful conservative management, to the best of our knowledge.