Laparoscopic repair of traumatic intraperitoneal bladder rupture: Case report and review of the literature

A case of traumatic rupture of the urinary bladder due to a fall from a chair-style ski lift

We report our experience with an 8-year-old boy who incurred a traumatic rupture of the urinary bladder due to a fall from a chair-type ski lift. This boy felt like he needed to urinate before getting on the lift, but he did not do so. He was trembling from the sensation of needing to urinate and fell from the lift while it was at least 6 m in the air. He complained of abdominal pain, and on-site emergency physicians performed focused assessment with sonography for trauma, which showed fluid in the abdomen. He subsequently developed abdominal guarding. Enhanced abdominal computed tomography revealed a rupture of the urinary bladder. At laparotomy, two ruptures were seen along the dome of the bladder; the bladder wall was repaired in three layers. The patient was discharged with a cast on his foot for a fracture of the left heel bone on postoperative day 16.

Delayed diagnosis of intraperitoneal bladder perforation after blunt trauma

Introduction

Intraperitoneal urinary bladder perforation due to blunt trauma in intoxicated patients requires quick and accurate diagnosis. However, this is difficult to correctly diagnose in intoxicated patients because their symptoms can be masked. We describe a rare case of intraperitoneal urinary bladder perforation that occurred after blunt trauma.

Case presentation

A 66‐year‐old intoxicated man stumbled, tripped on a stone step and landed on his lower abdomen, but felt no pain at the time. Two days later, he was diagnosed with intraperitoneal urinary bladder perforation, which was repaired by open surgery.

Conclusion

Urinary bladder perforation should be considered when patients present with abdominal pain and decrease in urine volume following trauma.

Laparoscopic repair in children with traumatic bladder perforation

Here, we report two patients with a traumatic intraperitoneal bladder dome rupture repaired by laparoscopic intracorporeal sutures. The first patient was a 3-year old boy was admitted with a history of road accident. He had a traumatic lesion on his lower abdomen and a pelvic fracture. Computed tomography (CT) scan revealed free intraabdominal fluid. The urethragram showed spreading contrast material into the abdominal cavity. Laparoscopic exploration revealed a 3-cm-length perforation at the top of the bladder. The injury was repaired in a two fold fashion. Post-operative follow-up was uneventful. The second case was a 3-year-old boy fell from the second floor of his house on the ground. He had traumatic lesion on his lower abdomen and a pelvic fracture. Due to bloody urine drainage, a cystography was performed and an extravasation from the dome of the bladder into the peritoneum was detected. On laparoscopy, a 3-cm long vertical perforation at the dome of the bladder was found. The perforation was repaired in two layers with intracorporeal suture technique. The post-operative course was uneventful. Laparoscopic repair of traumatic perforation of the bladder dome is a safe, effective and minimally invasive method. The cosmetic outcome is superior.

Laparoscopic repair of intra-abdominal bladder perforation in preschool children

Intraperitoneal bladder rupture is uncommon in very young children, but its incidence may increase with increasing use of seat and lap belts. To the best of our knowledge, there are no prior reports of laparoscopic repair of this injury in children. We describe two recent cases and discuss useful technical points that facilitate a successful laparoscopic repair. Both our patients were preschool age girls who sustained seat and lap belt injuries. Contrast computed tomography scan suggested a large amount of free peritoneal fluid and cystogram confirmed intraperitoneal bladder perforation (isolated injury). The injury was repaired using delayed absorbable sutures and intracorporeal suturing (continuous in 1, interrupted in 1) using a 3 port laparoscopic technique. Meticulous peritoneal lavage was carried out to minimise urinary peritonitis and the bladder as well as the peritoneal cavity were drained. Check cystograms (day 7) revealed no leaks. Young girls appear to be at risk of intraperitoneal bladder injuries following lap belt injuries. After exclusion of life-threatening injuries and concurrent abdominal injuries which need rapid control or preclude pneumoperitoneum, a laparoscopic repair can be safely performed.

Combination injuries of diaphragm and urinary bladder resulting urinothorax

Isolated diaphragmatic or urinary bladder injuries are uncommon, but rare are combination of these injuries. We report a rare case of urinothorax occurred as a result of combination injury of diaphragm and urinary bladder and our successful laparoscopic only management. A 26-year-old male presented with a history of trauma and features suggestive of bilateral pleural effusion. Radiological investigations revealed diaphragmatic and urinary bladder rupture. Laparoscopic examination of the abdomen confirmed the presence of ruptures and successful repair of both defects were done laparoscopically. High index of suspicion and early diagnosis are crucial for a better outcome in the management of diaphragmatic rupture. Laparoscopic management is a feasible and successful method in trained hands.

Intraperitoneal urinary bladder perforation observed in a patient with an indwelling urethral catheter

This report describes a rare case of an 86-year-old man with an indwelling urethral catheter who developed severe abdominal pain and was diagnosed with intraperitoneal urinary bladder perforation. A home-visiting nurse suspected catheter obstruction and performed a catheter exchange. However, bladder irrigation could not subsequently be performed. Computed tomography of the abdomen and pelvis after transurethral perfusion of contrast medium demonstrated extravasation of the contrast material into the peritoneal cavity. Furthermore, the Foley catheter balloon was positioned in the peritoneal cavity through the bladder. The patient was diagnosed with peritonitis due to spontaneous intraperitoneal perforation of the urinary bladder, and exploratory laparotomy was performed. During exploration, a perforated tear at the top of the bladder was discovered where the Foley catheter had penetrated the bladder. The Foley catheter balloon was floating freely in the peritoneal cavity. There was no evidence of pathologic lesions, such as cancer or inflammatory mass at the site of the injured peritoneum. Successful closure of the damaged peritoneum and bladder was performed. Since the proportion of elderly individuals continues to increase in the general Japanese population, the incidence of the chronic Foley catheterization is expected to increase. Therefore, clinicians should be aware of this potential complication.