Patibandla Srihita, Amanuddin Syed Mohammed, Ansari Ali Z, Saeed Ali, Kratz Kurt
Obstetrics and Gynecology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA.
Pathology, Merit Health Wesley, Hattiesburg, USA.
Cureus. 2024 Mar 20;16(3):e56556. doi: 10.7759/cureus.56556. eCollection 2024 Mar.
Hysterectomy, one of the most common surgical procedures performed in women worldwide, assumes a very important role in the definitive management of diverse gynecologic conditions. This case report presents a compelling instance of an iatrogenic bladder perforation that occurred during laparoscopically assisted vaginal hysterectomy in a 47-year-old woman with a high body mass index, extensive surgical history, and postural orthostatic tachycardia syndrome. Despite considerable preoperative planning and the use of minimally invasive techniques, the occurrence of physician-induced bladder perforation highlights the significance of understanding anatomical relationships and variations. The patient's previous abdominal surgeries including two cesarean sections, appendectomy, and cholecystectomy likely contributed to scar formation and adhesions, making dissection challenging. The case report and following discussion delve into anatomical variations, as well as the diagnosis and management of iatrogenic bladder injuries. The presented case serves as a valuable addition to the literature, contributing insights into the challenges and considerations surrounding urinary tract injuries during hysterectomy. This paper aims to review current research and guide practicing obstetricians and gynecologists in the management of intraoperative bladder injuries.
子宫切除术是全球女性最常进行的外科手术之一，在多种妇科疾病的最终治疗中发挥着非常重要的作用。本病例报告展示了一例引人关注的医源性膀胱穿孔病例，该病例发生在一名47岁、体重指数高、有广泛手术史且患有体位性直立性心动过速综合征的女性患者进行腹腔镜辅助阴道子宫切除术期间。尽管术前进行了充分的规划并采用了微创技术，但医源性膀胱穿孔的发生凸显了了解解剖关系和变异的重要性。患者既往的腹部手术，包括两次剖宫产、阑尾切除术和胆囊切除术，可能导致了瘢痕形成和粘连，使解剖操作具有挑战性。该病例报告及后续讨论深入探讨了解剖变异以及医源性膀胱损伤的诊断和处理。该病例为文献增添了有价值的内容，有助于深入了解子宫切除术期间尿路损伤相关的挑战和注意事项。本文旨在回顾当前的研究，并指导执业妇产科医生处理术中膀胱损伤。
