Kefalas Charalampos, Menni Alexandra, Karlafti Eleni, Panidis Stavros, Chatziantoniou Georgios, Katsiafliaka Konstantina, Krokou Despina, Ioannidis Aristeidis, Goulas Patroklos, Netta Smaro, Paramythiotis Daniel
1st Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
Emergency Department, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
J Pers Med. 2023 Apr 21;13(4):696. doi: 10.3390/jpm13040696.
Bladder rupture is more frequently encountered in blunt pelvic trauma, but can also be spontaneous or iatrogenic. Laparoscopic repair has been widely used during the last few years as a treatment for intraperitoneal bladder perforation. The bladder is the genitourinary organ most often affected by iatrogenic injury. The purpose of this article is to report what is, to our knowledge, the first documented case of bladder rupture as a complication of laparoscopic cholecystectomy.
A 51-year-old female presented to the emergency department complaining about generalized abdominal pain on the sixth postoperative day after laparoscopic cholecystectomy. Laboratory results highlighted a significant impact on renal function while the abdominal CT scan demonstrated free intraperitoneal fluid collection and surgical clips in the anatomic region of the liver and in an ectopic position near the ileocecal valve. An explorative laparoscopy revealed a 2 cm defect in the superior bladder wall, which was repaired in one layer in a continuous-locking fashion. The patient was discharged home on the fifth postoperative day having an uneventful recovery.
Bladder rupture frequently presents with non-specific clinical signs; as a result, it is easily misdiagnosed, especially when it occurs with a non-typical mechanism of injury. Pseudorenal failure is a relatively obscure entity that may help the clinician suspect a bladder perforation. Laparoscopic repair with a single-layer continuous suture technique is a safe and feasible treatment in hemodynamically stable patients. Prospective research is required to specify the optimal timing of catheter removal after bladder repair.
膀胱破裂在钝性骨盆创伤中更为常见，但也可能是自发性或医源性的。在过去几年中，腹腔镜修复已被广泛用于治疗腹膜内膀胱穿孔。膀胱是最常受医源性损伤影响的泌尿生殖器官。本文的目的是报告据我们所知首例记录在案的膀胱破裂作为腹腔镜胆囊切除术并发症的病例。
一名51岁女性在腹腔镜胆囊切除术后第六天因全身腹痛就诊于急诊科。实验室检查结果显示对肾功能有显著影响，而腹部CT扫描显示腹膜内有游离液体聚集，肝脏解剖区域及回盲瓣附近异位位置有手术夹。探查性腹腔镜检查发现膀胱上壁有一个2厘米的缺损，以连续锁边方式进行了一层修复。患者术后第五天出院，恢复顺利。
膀胱破裂常表现为非特异性临床症状；因此，很容易误诊，尤其是当损伤机制不典型时。假性肾衰竭是一个相对模糊的实体，可能有助于临床医生怀疑膀胱穿孔。对于血流动力学稳定的患者，采用单层连续缝合技术进行腹腔镜修复是一种安全可行的治疗方法。需要进行前瞻性研究以确定膀胱修复后拔除导管的最佳时机。
