Presentation
Persistent pain following change of indwelling bladder catheter 12 hours earlier. Multiple prior transurethral resections of prostate.
Patient Data
The urinary catheter tip penetrates through the bladder dome and is surrounded by fluid and inflammatory fat-stranding.
Contrast medium was injected through the urinary catheter confirming bladder perforation. Contrast medium fills the bladder and flows around the catheter tip to the peritoneal cavity outlining bowel loops and extending into the left paracolic gutter.
Incidental rectosigmoid “fecaloma”.
Case Discussion
Bladder perforation is an uncommon but serious complication that can complicate procedures such as cystoscopy, urinary catheterization or abdominal surgery. Bladder rupture can be intraperitoneal, extraperitoneal, or mixed, depending on the site of perforation.
Symptoms vary depending on the cause and severity of the injury and may include abdominal pain, hematuria, difficulty urinating, or urinary incontinence. Complications include infection, abscess formation or urinary obstruction.
Treatment for bladder perforation will depend on the cause and severity of the injury. Options include antibiotics and observation, suprapubic catheter or surgical repair. Early diagnosis and treatment lead to a better outcome.
In our case, intraperitoneal bladder perforation was repaired laparoscopically and recovery was uneventful.