Enigmatic Case of Bladder Hematoma Masquerading as Massive Hemoperitoneum in Postpartum Phase: Cystoscopic Management

Abstract

Significant spontaneous bladder trauma at vaginal birth is rare and affects <1% of deliveries. Bladder contusion resulting in urinary retention 5 days after normal delivery is being described here in a 23-year-old primiparous lady who underwent cystoscopic fulguration of the bleeder. Early diagnosis and prompt treatment can prevent long term, irreversible damage to the detrusor muscle that can have a permanent impact on a woman’s quality of life. A multidisciplinary surgical team comprising gynaecologists, urologists and anaesthetists carried out examination under anaesthesia and cystoscopy. An arterial bleeder below the interureteric ridge in the area of bladder neck was identified and coagulated with Resectoscope loop to secure hemostasis ensuring a safe distance from both ureteric orifices. Postoperative continuous bladder drainage for 3 weeks resulted in complete recovery. Careful evaluation of the stable patient with radiologic imaging and endoscopic management in competent hands should be considered before proceeding with any open surgical procedure in such cases