Laparoscopic management of spontaneous intraperitoneal perforation of urinary bladder.

The authors present two cases of spontaneous intraperitoneal perforation of urinary bladder. The first case was a 56-year old female patient with history of urothelial cancer with partial urinary bladder resection and subsequent radiotherapy six years ago. The diagnostic laparoscopy was indicated because of the clinical signs of peritonitis. The diagnostic laparoscopy revealed a perforation of urinary bladder and the management of perforation was done laparoscopically. The histological examination of specimen revealed urothelial cancer. The postoperative course was uncomplicated and the patient underwent further oncologic treatment. The second patient was a 61-year old man admitted with abdominal pain lasting for one day after excessive alcohol intake. An indication to diagnostic laparoscopy was done according to the clinical signs of peritonitis. Also in this case, perforation of urinary bladder was identified and laparoscopic management was carried out. The postoperative course was uncomplicated. Both patients denied any trauma. The diagnosis of urinary bladder perforation was not done preoperatively. The diagnosis of spontaneous perforation of urinary bladder is difficult. The case history data with no trauma do not lead to this diagnosis. It is important to consider this diagnosis in case of acute abdomen. The treatment of urinary bladder perforation is based on the identification of the defect, lavage of the peritoneal cavity, excision of the defect, reconstruction of the bladder with intact blood supply, bladder drainage supporting the defect healing, and exclusion of malignancy. The laparoscopic treatment of spontaneous perforation according to literature is not common, however very effective (Fig. 1, Ref. 41).