Clinical study, management and outcome of gall bladder perforation in a tertiary care hospital

Background: The objective of the study was to present our clinical experience with gall bladder perforation cases. This may help in the management and decision making of such cases.Methods: Records of 480 patients who received medical and/or surgical treatment with the diagnosis of acute cholecystitis in our hospital between 2007 and 2014 were reviewed retrospectively. Twenty nine (6%) of those patients had gall bladder perforation. Original Niemeier’s classification of gall bladder perforation used to describe the type of perforation. The parameters including age, gender, duration of symptoms, diagnostic procedures, medical or surgical or radiological interventional treatment used, morbidity and mortality were evaluated.Results: Out of the 29 patients, 25 patients had subacute type of gall bladder perforation (Niemeier type II) and 4 patients had chronic (Niemeier type III) perforation. None of the patients encountered had generalized peritonitis (Niemeier type I). The diagnosis in all these patients was established on admission to the hospital by means of abdominal ultrasound and computed tomography. Twelve (43%) patients underwent early surgery. The rest (58.6%) either underwent conservative medical line of management or pigtail catheter insertion in the collection followed by interval cholecystectomy. Three (10.7%) patients died of sepsis and associated comorbid condition.Conclusions: Early diagnosis of gall bladder perforation is of critical importance. Abdominal ultrasound coupled with computerized tomography is useful in diagnosis of gall bladder perforation. Management strategies include early surgery in patients with generalized peritonitis or suspicion of gall bladder necrosis, and initial conservative line of management and/or pigtail insertion in surgically high risk patients which can be followed up by interval cholecystectomy.

Spontaneous Idiopathic Perforation Of Gall Bladder In Neonates

This is a case series of 3 neonates with features of acute abdomen. The first neonate presented on day 6 of life with convulsions and fever. He developed abdominal distension and had bilious vomiting by day 11 of life. After clinical and radiological diagnosis of intestinal obstruction and failure to resolve with conservative management, laparotomy was done which revealed multiple inter bowel loop adhesions and an omental band adherent to distal ileum. On exploration, a localised abscess was seen around the gall bladder , a 0.5cm diameter perforation in the gall bladder. Exploratory laparotomy with cholecystectomy was done. The other two neonates presented with similar features and exploratory laparotomy with cholecystectomy was done. Perforation of the gall bladder is a rare cause of neonatal intestinal obstruction. The management is surgical and cholecystectomy or sewing the perforation should depend on the size of the perforation and the extent of peritonitis

A Case of Acute Aluminum Encephalopathy with Intraperitoneal Bladder Rupture Following Aluminum Bladder Irrigation in a Patient with Normal Renal Function / 대한내과학회지

Acute aluminum intoxication is uncommon in clinical practice but can be fatal. Most cases have been reported in patients with decreased renal function, especially dialysis patients. We describe a case of acute aluminum encephalopathy with intraperitoneal bladder rupture following aluminum bladder irrigation in a patient with normal renal function. A 51-year-old woman with a radical hysterectomy and external irradiation therapy for cervical cancer 15 years earlier was admitted due to gross hematuria. An aluminum intravesical irrigation was performed. After 1 day of intravesical irrigation, abdominal pain and fever developed. Abdominal CT images demonstrated bladder perforation and peritonitis. An emergency laparotomy was performed. Operative findings showed a perforated dome of the bladder with gray colored peritoneal fluids. Two days after the operation, she complained of numbness and pain in the left side of her face. Acute aluminum encephalopathy was diagnosed after excluding infectious, rheumatological, and other vascular causes. She was treated with combined intravenous deferoxamine and hemodialysis.

The factors and treatments of lower urinary tract injury caused by tension-free vaginal tape procedure / 中华泌尿外科杂志

Objective To discuss the influent factors and managements of lower urinary tract injury caused by tension-free vaginal tape (TVT) procedure. Methods From Mar.2001 to Feb.2011,609stress urinary incontinence (SUI) patients were trested by TVT.Lower urinary tract injury appeared in 39 cases (6.4％),which age from 39 to 78 years (average age 52.7 ± 18.3).The history of disease was 2 to 12 years.Preoperative SUI types were 12 cases of Ⅱ type SUI,22 cases of Ⅱ/Ⅲ type SUI and 5 cases of Ⅲ type SUI.The patients who had low urinary tract injury were retrospective analyzed to figure out the causes and influent factors,and recorded the treatments and follow-ups. Results 39 patients (6.4％) suffered from low urinary tract injury,including 36 oases (5.9％) of bladder perforation and 3 cases of urethral injury.In these 39 patients,34 (87.2％) patients had history of pelvic surgeries,including 18 (52.9％) cases of total hysterectomy,9 (26.5％) cases of cesarean section delivery,4 (11.8％) cases of hysteromyomectomia and 3 (8.8％) cases of ovarian surgery.All of the 36 bladder peeroration patients were re-punctured and the catheter was kept for 4 - 5 d.Three urethral injury patients were re-punctured after the urethral rupture was sutured and the catheter was kept for 2 weeks.All the 39 patients were cured and discharged.No urinary fistula,infection or other postoperative complications occurred. Conclusions The history of pelvic surgery may be an important risk factor of the lower urinary tract injury,which should pay attention.If the bladder perforation occurred,re-puncture should be taken by adjust the direction.If there was a urethral injury,the re-puncture should be taken after the suturing of the urethral rupture.

Dispositivo intrauterino intravesical en expulsión en embarazo de tercer trimestre: reporte de un caso / Intravesical migration of intrauterine device in a pregnant woman

Se estima que en el mundo cerca de 160 millones de mujeres son usuarias de dispositivos intrauterinos (DIU), siendo Chile uno de los países con más alta tasa, con cerca del 70 por ciento de las usuarias en el sistema público. Sin embargo, su uso no está exento de complicaciones. Presentamos un caso infrecuente de DIU intravesical en expulsión en gestante de 28 semanas.

In the world, about 160 million women are users of intrauterine devices (IUD); Chile is one of the countries with the highest rate, with about 70 percent of users in public system. However, its use may be complications. We present an unusual case of intravesical IUD expulsion in 28 weeks pregnant.

Intraperitoneally Placed Foley Catheter via Verumontanum Initially Presenting as a Bladder Rupture

Since urethral Foley catheterization is usually easy and safe, serious complications related to this procedure have been rarely reported. Herein, we describe a case of intraperitoneally placed urethral catheter via verumontanum presenting as intraperitoneal bladder perforation in a chronically debilitated elderly patient. A 82-yr-old male patient was admitted with symptoms of hematuria, lower abdominal pain after traumatic Foley catheterization. The retrograde cystography showed findings of intraperitoneal bladder perforation, but emergency laparotomy with intraoperative urethrocystoscopy revealed a tunnel-like false passage extending from the verumontanum into the rectovesical pouch between the posterior wall of the bladder and the anterior wall of the rectum with no bladder injury. The patient was treated with simple closure of the perforated rectovesical pouch and a placement of suprapubic cystostomy tube.

Sudden hypothermia after bladder perforation during transurethral bladder tumor resection: A case report

Transurethral resection is frequently performed urologic operation for benign prostate hypertrophy, prostate cancer, bladder cancer. During transurethral resection, urologists generally use room temperature irrigation fluid, and there is a chance that patients will run into hypothermia. Hypothermia may lead to arrhythmia, reduction of cardiac output, coagulation disorder, metabolic acidosis, and further serious life threatening complications. This case describes a sudden drop in core temperature due to bladder perforation and intraperitoneal leakage of irrigation fluid during transurethral resection of bladder tumor.

Sudden hypothermia after bladder perforation during transurethral bladder tumor resection: A case report

Transurethral resection is frequently performed urologic operation for benign prostate hypertrophy, prostate cancer, bladder cancer. During transurethral resection, urologists generally use room temperature irrigation fluid, and there is a chance that patients will run into hypothermia. Hypothermia may lead to arrhythmia, reduction of cardiac output, coagulation disorder, metabolic acidosis, and further serious life threatening complications. This case describes a sudden drop in core temperature due to bladder perforation and intraperitoneal leakage of irrigation fluid during transurethral resection of bladder tumor.

Pneumomediastinum due to inadvertent bladder perforation during transurethral resection of the prostate : A case report / 대한마취과학회지

Transurethral resection of the prostate (TURP) is a common procedure for managing benign prostatic hyperplasia (BPH), and this procedure is associated with low complication rates. Bladder perforation is an unusual complication of TURP, and it may create an air leak into the retroperitoneal space. Here we describe a case of pneumomediastinum, pneumoretroperitoneum and subcutaneous emphysema that were all due to a bladder perforation that occurred during performing TURP in a 74-year-old male patient with BPH.

Transurethral Resection Syndrome Occurred by Bladder Perforation during Transurethral Resection: A case report / 대한마취과학회지

A transurethral resection of the prostate (TURP) is often performed to treat benign prostatic hypertrophy or prostatic carcinoma. Transurethral resection syndrome (TURS) is a rare but serious complication of TURP that has two different causes: (1) intravascular absorption of the irrigation fluid through the open prostatic venous sinus (TURP syndrome); and (2) intraperitoneal extravasation of the irrigation fluid through perforation of the bladder. In general, a laparotomy, repair of injury, or conservative approach such as bladder drainage, percutaneous drainage of the abdomen combined with medical treatment are performed to manage TURS attributed to the latter mechanism. We report a patient with TURS, who showed a gradual onset of hyponatremia after bladder perforation and intraperitoneal extravasation of the irrigation fluid, and was treated successfully using a conservative approach.

Bladder perforation from capsaicin infusion : A case report.

We reported a 36 year old patient, with a spinal cord lesion who had bladder perforation during an infusion of 400 mls of Capsaicin (1mMol in 30% alcohol) for treatment of detrusor hyperreflexia. Under spinal anesthesia during the procedure he was restless and complained of chest discomfort. The operation was therefore terminated and a cystogram was carried out. Cystography showed extraperitoneal leakage of contrast media. He was treated conservatively and had an uneventful post-operative period. To prevent this complication, we therefore recommend an infusion volume of Capsaicin of between half to two-thirds of the patients bladder capacity together with pressure monitoring during the procedure.

Transurethral resection of bladder tumor under block anesthesia of bilateral obturator nerves / 中国微创外科杂志

Objective To study the safety and efficacy of transurethral resection of bladder tumor(TURBt)under block anesthesia of bilateral obturator nerves.Methods Seventy-seven patients were chronologically divided into two groups.Forty-six of patients with lateral,bilateral or multiple tumors in the bladder,which underwent transurethral resection of bladder tumor under epidural anesthesia from April 2003 to October 2004,were chosen as the Control Group.Thirty-one patients whom were administrated with epidural anesthesia plus bilateral block of the obturator nerve from October 2004 to July 2005 served as the Study Group.Incidences of bladder perforation and obturator nerve reflex were compared between the two groups.Results In the Control Group,obturator nerve reflex occurred in 25 patients(including intense reflex in 11 patients),giving an incidence of 54.3%(25/46),and bladder perforation resulted from the reflex was observed in 8 patients,with an incidence of 17.3%(8/46).In the Study Group,slight obturator nerve reflex happened in 3 patients(9.9%,3/31)and bladder perforation was found in 1 patient(3.2%,1/31).A significant higher rate of obturator nerve reflex was noted in the Control Group than in the Study Group(?2=15.970,P=0.000),but no statistical difference was seen in bladder perforation rate between the two groups(?2=2.359,P=0.125).Conclusions Bilateral block of the obturator nerve can improve the safety remarkably during transurethral resection of bladder tumor,especially when the tumor was located in the lateral bladder wall.

A Case of Neonatal Urinary Ascites due to Bladder Perforation Treated with Urinary Drainage

Urinary ascites in newborns is a rare event that usually is associated with posterior urethral valves and other obstructing anomalies of the genitourinary tract. A case of neonatal urinary ascites without genitourinary tract abnormalities is reported. This premature male neonate was treated by artificial ventilation due to respiratory distress syndrome. The umbilical artery catheter was placed without difficulties and functioned well until removal. Periumbilical leak of urine was not observed. He showed abdominal distension and oliguria on second postnatal day. He was found to have ascites, hyponatremia and elevation of BUN content disproportionate to the mild elevated serum creatinine value. Radiological examination revealed normal genitourinary tract except intraperitoneal extravasation of contrast material from the bladder. Conservative management resulted in complete resolution of the lesion in this patient.

The value of immediate postoperative cystogram in transurethral prostatectomy

Twenty-five consecutive cystograms were performed immediately following transurethral prostatectomy. The value of routine post-operative cystograms was demonstrated. It enables the resectionist to confirm not only visible perforations, but also enables him to diagnose occult extravasations. Significant vascular absorption can also be demonstrated. These findings forewarn the Resectionist of any likely post-operative complication. The management of bladder perforation and urinary extravasation was also discussed. (Summary)