Bladder perforations in children.

CONTEXT: Bladder perforations in children occur due to several different reasons. AIM: In this clinical series study, we focused on bladder perforations due to the pelvic injury, and our aim also was to create awareness for a rare type of bladder injuries. SETTING AND DESIGN: This was a retrospective study of the patients who were treated in our clinic for bladder perforation between 2006 and 2011. SUBJECTS AND METHODS: We reviewed the documents of childhood bladder perforations, and demographic and clinical characteristics of the patients were obtained. No statistical analyses were used because of the limited number of cases. RESULTS: There were ten patients who suffered from bladder perforation in 5-year period; 5 were male, and 5 were female. The mean age of the patients was 4.35 years. Four patients (40%) experienced iatrogenic perforation and six patients (60%) experienced perforation due to the accident. Common symptoms were hematuria, abdominal tenderness, and inability to urinate. Three patients were diagnosed via emergency laparotomy, without any radiological examinations performed before surgery. Four patients suffered from the intraperitoneal perforation, three patients suffered from extraperitoneal injury and three of them both of intraperitoneal and extraperitoneal injuries. Mean recovery time for patients was 15 days. One patient developed a urinary tract infection and one newborn died due to accompanying morbidities. Nine patients were discharged from the hospital. CONCLUSION: If the patients had a pelvic injury, surgeons must pay attention for the bladder perforation. Isolated bladder perforations are rare, and they are generally associated with iatrogenic injuries. Clinicians should pay attention to findings such as anuria, inability to insert a urinary catheter, and free fluid in the abdomen in order to diagnose the bladder perforation in newborns. Novice surgeons should pay more attention to avoid causing iatrogenic bladder perforation during inguinal hernia repair.

Role of single-dose clostridiopeptidase A collagenase in peritoneal adhesions.

BACKGROUND: To evaluate the effect of clostridiopeptidase A collagenase (CAC) in a rat model of postoperative peritoneal adhesion (PPA). METHODS: Forty rats were divided into four equal groups. In group 1, 1 g CAC was injected into the peritoneal cavity. In group 2, adhesions were generated. In group 3, adhesions were generated, and, 10 days later, the area with PPAs was covered with 1 g CAC. In group 4, adhesions were generated and the area was covered immediately with 1 g CAC. All rats were sacrificed on postoperative day 10, and adhesions were scored both macroscopically and microscopically. RESULTS: Mean macroscopic adhesion scores in groups 1-4 were 0, 2.9 ± 0.21, 2.55 ± 0.16, and 1.3 ± 1, respectively (p = 0.0001). The mean macroscopic adhesion score in group 4 was lower than that in group 2 (p = 0.045). The mean macroscopic adhesion score in group 4 was lower than that in group 3, but the value was not statistically different (p = 0.098). Mean microscopic values were 0, 2.8 ± 0.42, 2.5 ± 0.52, and 1.3 ± 0.67, respectively (p< 0.0001). The group 4 score was lower than those of groups 2 (p = 0.01) and 3 (p = 0.025). DISCUSSION: A single dose of CAC reduces PPA formation. CAC, however, is not effective on already formed PPAs.

Isolated terminal ileum perforation after a kick blow to an inguinal hernia.

Small bowel perforation caused by direct blunt trauma to an inguinal hernia has rarely been reported. In this report, we present a patient with terminal ileum perforation after direct blunt trauma to an inguinal hernia region. Both perforation and hernia repair were managed surgically in the same stage. This case demonstrates that leaving an inguinal hernia unrepaired may lead to dangerous outcomes, such as intestinal strangulation and perforation. Inguinal hernias with intestinal perforation need urgent surgical intervention. It is possible to repair the intestinal perforation and inguinal hernia in the same operation.