Urinary Peritonitis due to Unrecognized Bladder Injury During Laparoscopy: A Case Report

Abstract

Bladder injury is a possible complication of laparoscopic surgery. If it is not identified, the subsequent clinical presentation is usually unclear and confusing. We report the case of a 31-year-old patient without an obstetric history. A laparoscopic ovarian cystectomy was performed and a bladder perforation due to the use of an accessory suprapubic trocar must have occurred. However, the perforation was not identified as such during the operation nor in the postoperative period. This injury subsequently caused unclear symptoms with diffuse and persistent abdominal pain, sometimes intense and focused on the right side, in the days following the surgery. The observation of the globe of the Foley catheter with trasvaginal ultrasound in an extravesical location suggested bladder injury with spilling of the urine and catheter into the peritoneal cavity. An immediate laparotomy was performed, revealing a small bladder perforation on the front pre-peritoneal face and another 1-cm perforation in the upper part of the bladder that were corrected. Post-surgical progress was then normal. A high urachal vesical extension or filled bladder, no visual control or a too-low introduction of the suprapubic trocar can produce an unrecognised bladder perforation. Attention must be paid to irritating and persistent abdominal pain of urinary peritonitis, presumed anuria corrected after the positioning of the Foley catheter, variable haematuria, leukocytosis, and eventual electrolytic alterations without fever. The key to the diagnosis of bladder injury is awareness of this clinical entity. doi: http://dx.doi.org/10.4021/wjnu83e