PEDIATRIC SURGERY UPDATE ©

VOLUME 52 NO 06 JUNE 2019

Laparoscopic Bladder Injury

Laparoscopy is a standard technique utilized in many surgical procedures proving itself important in as much as convalescence, less postoperative pain, better cosmesis and less hospital stay refers. Inserting trocar cannulas into the abdominal cavity can cause iatrogenic injury to intraabdominal organs, namely, blood vessels, viscera and bladder. Bladder injury during laparoscopy is very rare occurring with an estimated incidence of 0.5% of all general surgery laparoscopic procedures. The risk is increased in children due to smaller operative field. Most cases of bladder injury occur during emergency procedures performed in and toward the pelvis. Laparoscopic appendectomy is the procedure most commonly associated with bladder injury in children. Hollow organs should be decompressed to minimize damage to these structures during laparoscopy. Placement of a bladder catheter (Foley) during pelvic procedures, including appendectomy, reduces but does not eliminate the possibility of causing injury to the bladder. Bladder injury occurs during suprapubic trocar placement (most commonly) or while dealing with an inflammatory procedure near the bladder. Bladder injury can also occur if a urachal remnant is injured during suprapubic trocar insertion. In the immediate postop period a child with laparoscopic bladder injury will show suprapubic pain, hematuria, urinary retention, urinary leakage from wound sites, cystitis or even a subtle rise in creatinine. The systemic inflammatory response can include suprapubic cellulitis and crepitation from an underlying infection if the injury is delayed. Most trocar injuries produce a through and through perforation of the bladder tangentially or including two holes. The diagnosis of bladder injury is established with contrast cystogram. Findings could be of extraperitoneal or intraperitoneal bladder injury. Extraperitoneal injury can be managed conservatively with bladder drainage and antibiotics. Intraperitoneal bladder injury needs operative repair.    

References:
1- Levy BF, De Guara J, Willson PD, Soon Y, Kent A, Rockall TA: Bladder injuries in emergency/expedited laparoscopic surgery in the absence of previous surgery: a case series. Ann R Coll Surg Engl. 94(3):e118-20, 2012
2- Lad M, Duncan S, Patten DK: Occult bladder injury after laparoscopic appendicectomy. BMJ Case Rep. 2013 Nov 22;2013. pii: bcr2013200430. doi: 10.1136/bcr-2013-200430.
3- Hotonu SA, Gopal M: Bladder injury in a child during laparoscopic surgery. J Surg Case Rep. 2019 Feb 19;2019(2):rjz043. doi: 10.1093/jscr/rjz043. eCollection 2019 Feb.
4- Deshpande AV, Michail P, Gera P: Laparoscopic repair of intra-abdominal bladder perforation in preschool children. J Minim Access Surg. 13(1):63-65, 2017
5- Godfrey C, Wahle GR, Schilder JM, Rothenberg JM, Hurd WW: Occult bladder injury during laparoscopy: report of two cases. J Laparoendosc Adv Surg Tech A. 9(4):341-5, 1999
6- Ostrzenski A, Ostrzenska KM: Bladder injury during laparoscopic surgery. Obstet Gynecol Surv. 53(3):175-80, 1998

     Malfunctioning Peritoneal Dialysis

*Edited by: Humberto Lugo-Vicente, MD, FACS, FAAP
P.O. Box 10426, Caparra Heights Station, San Juan, Puerto Rico 00922-0426
Tel (787)-999-9450 Fax (787)-720-6103 E-mail: TITOLUGO@COQUI.NET
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Pediatric Surgery Update ISSN 1089-7739
Last updated: July 2019