ABSTRACT
INTRODUCTION AND IMPORTANCE: Bladder rupture, or perforation, is the rupture of the urinary bladder, which is often clinically classified as intraperitoneal, extraperitoneal, or combined types. Spontaneous bladder perforation is an extremely rare event and constitutes less than 2 % of bladder ruptures. It is often associated with previous bladder manipulation, lower urinary tract obstruction, instrumentation, pelvic radiotherapy or surgery, inflammation, and malignancy. Blood work will demonstrate leukocytosis with left shift, hematuria on urinalysis, and an ascites to serum creatinine ratio of more than one, which is highly suggestive of bladder rupture. CASE PRESENTATION: A 38-year-old male patient presented with abdominal pain for 8 h and loss of consciousness lasting 4 h. The patient was acutely sick-looking with borderline blood pressure of 90/60 mmHg, pulse rate of 120, and has alcoholic breath. With a diagnosis of viscus perforation, he was operated and there was a 1 × 1 cm bladder dome perforation, which looks fresh. The ruptured edge was refreshed and repaired in two layers. The patient has recovered well, discharged and was fine on subsequent follow-ups. CLINICAL DISCUSSION: Bladder rupture commonly develops after blunt abdominal trauma, of which more than 60 % is extraperitoneal. Intraperitoneal bladder rupture constitutes only a small fraction of all cases of rupture. There are only a few reports of spontaneous bladder rupture in the scientific literature. The risk of bladder rupture may be increased in the alcohol-impaired patient owing to decreased bladder filling sensation and abnormal behavioral responses. CONCLUSION: Bladder rupture is a rare diagnosis in surgical patients, and spontaneous rupture is by far a very rare finding. The diagnosis of bladder perforation is often overlooked preoperatively for the obvious reason of its rarity and non-specific presentation. Early identification and timely management decrease mortality.
ABSTRACT
INTRODUCTION AND IMPORTANCE: Bowel obstruction is a mechanical or functional blockade of intestinal contents from evacuation to the adjacent distal bowel or external environment. Cecal volvulus is the twisting of distal ileum, cecum and ascending colon on their mesentery. Transverse colon volvulus is another rare cause of large bowel obstruction even less prevalent than cecal volvulus. Colectomy with decompression stoma is the widely practice of intervention in cecal or transverse colon volvulus. CASE PRESENTATION: A 45 years-old male patient presented to our center with failure to pass feces and flatus of 5 days duration. He also had crampy abdominal pain, abdominal distention and vomiting of ingested matter. Vital signs were normal except mild tachycardia. He had distended non-tender abdomen, hyperactive bowel sound and hyper-tympanic percussion. However, there was no sign of fluid collection of abdominal or rectal mass. Plain abdominal X-ray showed distended large bowel loops with multiple air fluid levels. Exploratory laparotomy revealed simultaneous cecal and transverse colon clockwise volvulus 270 degrees on their mesentery. DISCUSSION: Mechanical bowel obstruction is major cause of surgical admission in both developed and developing countries. Anatomic and congenital factors play significant role in both transverse colon and cecal volvulus. Endoscopic decompression in the case of cecal and transverse colon volvulus is less probable and not recommended. CONCLUSION: Simultaneous cecal and transverse colon volvulus is an extremely rare occasion where there is no report in the history of literatures to date. Management involves extended right hemicolectomy with proximal diversion and distal mucus fistula.
