Abstract
An 80 year-old man presented to his primary care physician with painless gross hematuria. He reported having intermittent episodes of pink urine containing small clots for about three months. He was initially treated with a single course of ciprofloxacin for presumed urinary tract infection. His symptoms did not improve with antibiotic therapy and he was then referred to our institution for a computed tomography (CT) urogram. CT urogram showed a 4 x 3.6 centimeter (cm) infiltrating solid mass along the left lateral posterior wall of the urinary bladder (Figure-1). Tumor also extended along the bladder dome. Prostate enlargement and bladder diverticula were also present. He was referred to the urology service and subsequently underwent transurethral resection of bladder tumor (TURBT) with fulguration. No intraoperative complications were noted and he returned to the recovery room in satisfactory condition on continuous bladder irrigation. Pathologic examination revealed a 5 cm transitional cell carcinoma with high grade growth pattern invading the deep muscular layer. On postoperative day one, the patient reported abdominal pain and general discomfort. Physical exam revealed a grossly distended abdomen which was tender to palpation with positive guarding and decreased bowel sounds. He Symptomatic Extraperitoneal Bladder Perforation Following Transurethral Bladder Surgery: Imaging with CT Urography _______________________________________________
Highlights
An 80 year-old man presented to his primary care physician with painless gross hematuria
The actual incidence of bladder perforation is difficult to estimate as small perforations remain unnoticed, one series reports an incidence of 1.3%
Extraperitoneal perforations are confined to the extraperitoneal space and imaging shows extravasation of contrast material close to the bladder, usually anteriorly, in a streaky and irregular pattern
Summary
An 80 year-old man presented to his primary care physician with painless gross hematuria. The patient reported abdominal pain and general discomfort. Bladder perforation was suspected and urgent CT urogram with multiplanar reformation (MPR) was performed. CT urogram showed irregular pooling of extravasated contrast into the left perivesical space via a disrupted left inferior lateral bladder wall, consistent with extraperitoneal bladder perforation (Figure-2).
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