Spontaneous isolated intraperitoneal rupture of urinary bladder after normal vaginal delivery presenting as puerperal sepsis

Spontaneous isolated intraperitoneal rupture of urinary bladder is a rare urological complication of normal delivery. This complication is usually related to prolonged labour, failure to empty bladder in second stage of labour, use of forceps/ ventouse, postpartum urinary retention, vaginal birth after caesarean section and usually presents immediately after delivery. We report the case of a patient with spontaneous isolated intraperitoneal rupture of urinary bladder after normal vaginal delivery in the absence of any risk factor. She presented on day 5 postpartum with features suggestive of puerperal sepsis with pyoperitoneum with acute kidney injury. Absence of unhealthy lochia and later, normal-looking uterus and adnexa during laparotomy led to the suspicion of alternate cause for seropurulent ascites. Further exploration revealed rent in the urinary bladder with necrosed margins. High index of suspicion of alternate diagnosis should be maintained if some of the clinical findings are not supportive of provisional initial diagnosis

Spontaneous Rupture of Urinary Bladder: Two Case Reports and Review of Literature

Objectives: Spontaneous rupture of the urinary bladder (SRUB) is extremely rare and might be misdiagnosed, leading to a high mortality rate. The current study aimed to identify the cause, clinical features, and diagnosis strategy of SRUB.Methodology: We presented a case report for two women (79 and 63 years old) misdiagnosed with acute abdomen and acute kidney injury, respectively, who were finally confirmed to have SRUB by a series of investigations and exploratory surgery. Meanwhile, literature from multiple databases was reviewed. PubMed, the Chinese National Knowledge Infrastructure (CNKI), the Chinese Biological Medical Literature Database (CBM), WANFANG DATA, and the Chongqing VIP database for Chinese Technical Periodicals (VIP) were searched with the keywords “spontaneous bladder rupture” or “spontaneous rupture of bladder” or “spontaneous rupture of urinary bladder.” All statistical analyses were conducted using SPSS 20.0 software.Results: A total of 137 Chinese and 182 English literature papers were included in this article review. A total of 713 SRUB patients were analyzed, including the two patients reported by us. The most common cause of SRUB was alcohol intoxication, lower urinary tract obstruction, bladder tumor or inflammation, pregnancy-related causes, bladder dysfunction, pelvic radiotherapy, and history of bladder surgery or bladder diverticulum. Most cases were diagnosed by exploratory laparotomy and CT cystography. Patients with extraperitoneal rupture could present with abdominal pain, abdominal distention, dysuria, oliguria or anuria, and fever. While the main symptoms of intraperitoneal rupture patients could be various and non-specific. The common misdiagnoses include acute abdomen, inflammatory digestive disease, bladder tumor or inflammation, and renal failure. Most of the patients (84.57%) were treated by open surgical repair, and most of them were intraperitoneal rupture patients. Overall, 1.12% of patients were treated by laparoscopic surgery, and all of them were intraperitoneal rupture patients. Besides, 17 intraperitoneal rupture patients and 6 extraperitoneal rupture patients were treated by indwelling catheterization and antibiotic therapy. Nine patients died of delayed diagnosis and treatment.Conclusions: SRUB often presents with various and non-specific symptoms, which results in misdiagnosis or delayed treatment. Medical staff noticing abdominal pain suggestive of peritonitis with urinary symptoms should be suspicious of bladder rupture, especially in patients with a history of bladder disease. CT cystography can be the best preoperative non-invasive examination tool for both diagnosis and evaluation. Conservative management in the form of urine drainage and antibiotic therapy can be used in patients without severe infection, bleeding, or major injury. Otherwise, surgical treatment is recommended. Early diagnosis and management of SRUB are crucial for an uneventful recovery.

Intraperitoneal Rupture of Liver Hydatid Cyst in Children

The article's abstract is not available.

SPONTANEOUS RUPTURE OF HYDATID CYST OF LIVER IN THE PERITONEAL CAVITY WITH INTACT PROLIGEROUS MEMBRANE: ABOUT ONE CASE AND LITERATURE REVIEW

Rupture of hydatid cyst of liver with intact proligerous membrane is rare. We report the case of a 63 year-old female patient presenting with right hypocondrium pain without fever or jaundice. Diagnostic imaging examination showed hydatid cyst in segment IV of liver associated with pelvic cystic lesion measuring 12 cm x 06 cm. Surgical exploration revealed ruptured unilocular hydatid cyst of the liver with intact proligerous membrane and free in the peritoneal cavity. This study aims to report a new case of intraperitoneal rupture of hydatid cyst of liver with intact proligerous membrane and to highlight the diagnostic and therapeutic difficulties due to this complication.

Features of the installation of a suprapubic cystostomy for laparoscopic treatment of patients with intraperitoneal bladder rupture

INTRODUCTION: In closed intraperitoneal bladder trauma, an alternative to laparotomy is laparoscopy. The rupture is closed with endoscopic sutures, and the bladder is drained with a urethral catheter. In the literature, the issue of the placement of a trocar cystostomy during laparoscopic treatment of patients with intraperitoneal bladder ruptures requiring prolonged drainage is insufficiently covered. PURPOSE OF THE STUDY: Determination of the optimal trocar cystostomy method during laparoscopic treatment of intraperitoneal bladder rupture. MATERIALS AND METHODS: Trocar cystostomy was performed in 8 patients with intraperitoneal bladder ruptures, among whom 7 had concomitant diseases of the prostate gland, and 1 had urethral stricture. Trocar cystostomy during laparoscopic surgery was performed in three different ways. Results. In the first method, the rupture of the bladder was initially sutured. Then, through the urethral catheter, the bladder was filled with saline. A trocar cystostomy was inserted through the suprapubic region. The second method consisted in the installation of a trocar cystostomy under the control of a laparoscope even before the suturing of the bladder rupture. In the third method proposed by us (patent No. 2592023), a Foley-type catheter with a balloon capacity of at least 200 ml was inserted into the abdominal cavity through the laparoscopic port. A catheter was inserted from the abdomen through an intraperitoneal rupture into the bladder. Inside the bladder, the catheter balloon was filled with saline. Then, through the suprapubic region, the anterior abdominal wall, the bladder and the inflated balloon of the catheter were pierced layer by layer with a trocar. Another catheter was inserted through the trocar into the bladder. After removal of the catheter with a ruptured balloon, the intraperitoneal rupture of the bladder was sutured. FINDINGS: According to the results of the study, the third method of inserting a trocar cystostomy turned out to be the most optimal and safe.

Comparison of surgical treatment of bladder rupture

Introduction. Еven though open bladder suturing is a traditional method of surgical treatment of intraperitoneal rupture of the bladder, laparoscopic bladder suturing is a prospective method for treating such injuries. Materials and methods. In N.V. Sklifosovsky Research Institute of Emergency Care during the period from January 2016 to April 2020, 22 patients with bladder injury were treated. 15 of them had an intraperitoneal rupture, 5 had an extraperitoneal rupture, and 2 had a bladder rupture. Among the affected men there were 15 (68%), women - 7 (32%), the average age of patients was 42 ± 18 years. The clinical picture was dominated by gross hematuria and pain in the lower abdomen. All patients underwent ultrasound examination (US) according to the FAST protocol, and cystography was performed in some patients. Results. 20 (91%) patients were operated and 2 (9%), with extraperitoneal rupture of the bladder, were drained by urethral catheters. Patients were divided by the method of surgical treatment into 2 groups. In the 1st group, 2 (10%) patients underwent laparoscopic suturing of the bladder with drainage of the bladder with a urethral catheter. 18 (90%) patients of the 2nd group underwent laparotomy with suturing of the bladder. Depending on the method of bladder drainage, patients were divided into the cystostomy group (group A) and the urethral catheter group (group B). Group A - 16 (73%) patients who underwent laparotomy, suturing a rupture or ruptures of the bladder, epicystostomy, drainage of the abdominal cavity and lower pelvis. Group B-4 (18%) patients after laparotomy, laparoscopy, as well as patients who underwent conservative therapy with the installation of an urethral catheter – 2 (9%). Discussion. In the world literature, there are few scientific articles on the laparoscopic method of treating bladder injury, and the presented works are based on a small sample of patients. But, despite this, the method seems to be a promising and effective method for treatment and can be used in patients with intraperitoneal rupture of the bladder with stable hemodynamics, without life-threatening concomitant injuries. Conclusion. Тhe use of open or laparoscopic suturing of the bladder without epicycostomy significantly reduces the hospital stay and allows to restore natural urination on average 7 days after surgery. Laparoscopic suturing of the bladder is an effective and alternative treatment for bladder rupture.