Bladder diverticulum/fistula after previous bladder cystectomy

Abstract

Bladder injury is a rare occurrence, because the bladder is located deep in the pelvis and is protected by the pelvis. With the increase of certain medical conditions, the risk of iatrogenic vesico-peritoneal fistula is increasing; however, iatrogenic vesico-peritoneal fistulas in the pediatric population are rarely reported in the literature. Two girls presented to our department with acute abdominal pain and urinary ascites, and both of them had underdone partial bladder cystectomies approximately 1 year ago to treatment urachal cysts and ureteroceles. Bladder diverticula were observed during the cystoscopies. We hypothesized that the bladder diverticula developed from insecure sutures, and laparoscopic vesical diverticulectomies and cystorrhaphies were performed in these two patients. A vesico-peritoneal fistula is a rare complication of partial bladder cystectomy, and vesico-peritoneal fistulas may cause acute abdominal pain and ascites that can lead to a misdiagnosis. Micturating cystourethrograms (MCUG) and cystoscopies should be performed in patients with abdominal pain and ascites who have previously had bladder surgery. Iatrogenic vesico-peritoneal fistulas in these patients might develop from insecure sutures. Care must be taken in suturing the bladder during bladder surgery to reduce this complication.