scholarly journals CAESAREAN SECTION AND BLADDER INJURY

2019 ◽  
Vol 3 (6) ◽  
Author(s):  
Dr. Manish Bhatt ◽  
Dr. Ela Bhatt
Keyword(s):  
Cesarean Section ◽  
Primary Repair ◽  
Foley Catheter ◽  
Household Survey ◽  
Population Level ◽  
Health Care Facilities ◽  
Tube Placement ◽  
Fistula Formation ◽  
Bladder Injury ◽  
Bladder Injuries

INTRODUCTION: Cesarean section is a live saving procedure but when performed without appropriate indications can add risk to both mother and baby. As per WHO report, at population level, Cesarean section rates higher than 10% are not associated with reductions in maternal and new-born mortality rates. In India as per District level household survey 3 (DLHS) Cesarean section rate is 28.1% in private sector and 12% in public sector health care facilities. The close embryonic development and anatomical proximity of the urinary bladder and genital organs, are responsible for the urinary tract to injury during surgical procedures in the female pelvis. During LSCS bladder injury is demonstrated by the presence of gas filling up the Foley bag or visibly bloody urine in the Foley bag. Veress needle injuries and other small injuries to the bladder can be successfully managed conservatively by catheter drainage for seven to 14 days followed by cystography while large bladder injuries, such as from 5 or 10 mm trocar or surgical dissection usually require suturing the injuries closed. Risk factors for bladder injury during LSCS include previous operations, expodure to radiation, malignancy, chronic infection, and inflammation. MATERIAL AND METHODS: In suspected cases of bladder injuries cystogram X-ray of the bladder after injection of contrast medium is performed. For extraperitoneal injuries (grade 2) without complicating factors, treatment is a insertion of Foley catheter for 7 - 14 days. grade 3 to grade 5 injuries generally require operative repair. Closed suction drains should be left in place after repairs. Suprapubic tube placement is not necessary in most cases. For injuries to the ventral bladder, dome, or posterior bladder, the mucosa is closed in a running fashion using 3-0 vicryl followed by a seromuscular running suture of 2-0 vicryl. The bladder is irrigated to ensure a watertight closure. A third layer in a Lembert fashion can be used in cases at high risk for fistula formation or when a leak is identified. In the laparoscopic setting, a one-layer closure is performed using 2-0 vicryl to close all layers of the bladder. An additional layer can then be added using a 2- 0 vicryl in a Lembert fashion for more extensive injuries. RESULTS: There were 986 LSCS done in the department of Obstetrics and gynaecology in the given study period. Of which 14 were diagnosed with the bladder injuries during. Among all patients who suffered from bladder injury, 3 cases were primigravida and 11 were multigravida type.  Out of 14injuries, 10 injuries were repaired in 2 layers by vicryl 2.0 without insertion of SPC (suprapubic cystectomy) whereas 4 injuries were repaired by primary repair with vicryl 2.0 with insertion of SPC. In post-operative period patients were monitored for vitals, urine output and stitch sites of wounds. No complications were found in 13 patients post operatively and Foleys catheter and SPC catheter were removed after 12 days of operation in those patients. CONCLUSION: 1.4% of the bladder injuries were observed. Early detection and prompt management of bladder injury can decrease the morbidity and mortality in LSCS cases

scholarly journals The Incidence, Management, and Outcome of Penetrating Bladder Injuries in Civilians Resultant from Armed Conflict in Baghdad 2005-2006

2009 ◽  
Vol 2009 ◽  
pp. 1-5 ◽  
Author(s):  
Firas G. Petros ◽  
Richard A. Santucci ◽  
Naimet K. Al-Saigh
Keyword(s):  
Primary Repair ◽  
Bladder Injury ◽  
Associated Injuries ◽  
Bladder Drainage ◽  
Young Males ◽  
Iraqi War ◽  
Missed Injury ◽  
War Zone ◽  
Civilian Trauma ◽  
Bladder Injuries

The purpose of this paper is to review the diagnosis, treatment, and outcomes of penetrating bladder injuries suffered by civilians in the Iraqi war zone.Materials and Methods.All civilian trauma cases received alive at Al-Yarmouk Teaching Hospital from January 2005 to August 2006 were reviewed for the presence of bladder injury.Results.533 cases of penetrating abdominal trauma were identified, of which 177 (33%) involved the genitourinary (GU) system and 64 (12%) involved the bladder. Most (70%) were young males, and most (55%) had grade IV injuries. Associated injuries occurred in 63/64 (98%) of patients. 3 patients had missed bladder injuries, and all of these had complications related to their missed injury. Bladder-related complications occurred in 11% of cases, and mortality in 13%, all due to extravesical injuries.Conclusions.Penetrating bladder injury among civilians in Baghdad war zone resulted in 64 cases in 18 months. The initial detection rate is very high (98%), and after primary repair, lasting complications are rare. Morbidities from missed injuries were severe hematuria and vesicorectal fistula. However, (3%) of vesicorectal fistulae healed spontaneously with prolonged bladder drainage. Associated injuries are the rule in penetrating bladder injury patients, and must be diligently investigated and treated.

scholarly journals Bladder injuries during obstetrical and gynecological surgeries

2017 ◽  
Vol 4 (7) ◽  
pp. 2177
Author(s):  
Beena Vaidya ◽  
Manish Chaudhari ◽  
Deep Parmar ◽  
Vipul Chaudhari ◽  
Taha Daginawala ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Bladder ◽  
Primary Repair ◽  
Bladder Injury ◽  
Interventional Study ◽  
Suprapubic Cystostomy ◽  
Urinary Tract Injury ◽  
Bladder Injuries ◽  
Gynaecologic Surgery

Background: The reproductive and urinary tracts in women are closely related anatomically and embryologically. Knowledge of this anatomy plays an important role in the prevention of urinary tract injury during gynaecologic surgery. The primary approach to prevention is careful surgical dissection and knowledge of the position of urinary tract structures within the surgical field.Methods: Prospective interventional study consisted of 28 patients with obstetrics and gynecological surgeries was carried out at department of surgery, new civil hospital, Surat during December 15th to January 16th. Out of 28 patients 13 patients had bladder injuries which repaired and studied in detail.Results: Out of these 28 patients undergone various obstetrics and gynecological surgeries, 13 patients were having iatrogenic urinary bladder injuries. Bladder injury occurred commonly during in LSCS and in hysterectomies. Out of 13 urinary bladder injuries, 8 injuries repaired in 2 layers by Vicryl 2-0 without insertion of SPC and 5 injuries were managed by primary repair with vicryl 2-0 with insertion of SPC (SPC= suprapubic cystostomy).Conclusions: Surgery adjacent to or within urinary bladder continue to result in occasional iatrogenic injury. These injuries can be minor with no long-term sequelae, or they can result in significant morbidity and inconvenience to patients.

scholarly journals Exploring the Relationship Between Palatal Cleft Type and Width With the Use of Relieving Incisions in Primary Repair

2021 ◽  
pp. 105566562110196
Author(s):  
Alex Davies ◽  
Amy Davies ◽  
Yvonne Wren ◽  
Scott Deacon ◽  
Alistair R.M. Cobb ◽  
...  
Keyword(s):  
Oral Mucosa ◽  
Primary Repair ◽  
Fistula Formation ◽  
The United Kingdom ◽  
Using Data ◽  
The Uk ◽  
The Relationship ◽  
Soft Edge ◽  
Intravelar Veloplasty ◽  
Pierre Robin

Objective: The mainstay of palatal repair in the United Kingdom is the intravelar veloplasty (IVVP). It is not always possible to align the oral mucosa in the midline to achieve tension-free repair. The addition of lateral relieving incisions may aid transposition of the oral mucosa to allow closure. The aim of this study was to explore cleft features that may predispose to a requirement for relieving incisions in order to allow palate closure. Design: We performed a national multiinstitutional retrospective study using data from the UK Cleft Collective cohort study. Patients: The study sample consisted of 474 patients who had undergone IVVP at the time of palatal closure across all 16 of the UK cleft units. Results: We found strong evidence for the requirement for relieving incisions in patients with an increased degree of clefting per the Veau classification ( P < .001), increasing palatal soft-edge width ( P < .001) and moderate evidence of an associated use in patients with Pierre Robin sequence ( P = .015). Insufficient data were available to explore the relationship between intertuberosity distance and the presence of fistula formation with the use of relieving incisions. Conclusions: The results of this study identify cleft features that increase the likelihood for requiring lateral relieving incisions to allow palatal closure. The degree to which the addition of relieving incisions to IVVP affects maxillary growth and speech outcomes is unknown. Further study is required to answer this important question.

scholarly journals Bladder injuries in emergency/expedited laparoscopic surgery in the absence of previous surgery: a case series

2012 ◽  
Vol 94 (3) ◽  
pp. e118-e120 ◽  
Author(s):  
BF Levy ◽  
J De Guara ◽  
PD Willson ◽  
Y Soon ◽  
A Kent ◽  
...  
Keyword(s):  
Case Series ◽  
Lower Abdominal Pain ◽  
Bladder Injury ◽  
Emergency Setting ◽  
Surgical Trainees ◽  
Bladder Injuries ◽  
Site Planning ◽  
Supervision And Training ◽  
Alternative Sites ◽  
And Training

INTRODUCTION The use of laparoscopy as a diagnostic and therapeutic tool is being used increasingly in the emergency setting with many of these procedures being performed by trainees. While the incidence of iatrogenic injuries is reported to be low, we present six emergency or expedited cases in which the bladder was perforated by the suprapubic trocar. CASES Three cases were related to the management of appendicitis, two to negative diagnostic laparoscopies for lower abdominal pain and one to an ectopic pregnancy. Management of the bladder injuries varied from a urinary catheter alone to laparotomy with debridement of the abdominal wall due to sepsis and later reconstruction. Four of the six cases were performed by registrars. CONCLUSIONS Although the incidence of bladder injury is low, its importance is highlighted by the large number of laparoscopies being performed. In addition to catheterisation of the patient, care must be taken with the insertion of low suprapubic ports and consideration should be made regarding alternative sites. Adequate laparoscopic supervision and training in port site planning is required for surgical trainees.

scholarly journals A CASE OF MYCOPLASMA HOMINIS INFECTION AFTER BLADDER INJURY DURING CESAREAN SECTION

2011 ◽  
Vol 102 (5) ◽  
pp. 705-708
Author(s):  
Yusuke Yagihashi ◽  
Keiji Kato ◽  
Kanji Nagahama ◽  
Masakazu Yamamoto ◽  
Hiroshi Kanamaru ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Mycoplasma Hominis ◽  
Bladder Injury ◽  
Hominis Infection

Penetrating bladder injuries: Description of a clinical case

1995 ◽  
Vol 62 (1_suppl) ◽  
pp. 190-191
Author(s):  
R. Borsa ◽  
M. Governa ◽  
G. Aimé ◽  
D. Fraire ◽  
E. Baralis ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Clinical Case ◽  
Bladder Injury ◽  
Pelvic Ultrasound ◽  
Bladder Injuries

— A penetrating bladder injury in a youth due to impalement through the scrotum was successfully operated. Perforation was at the bottom and on the dome and the absence of a clinical uro-peritoneal picture was due to the plugging of the latter rupture by the omentum. Retrograde urethrocystography was negative and only pelvic ultrasound characterised the diagnosis, leading to an immediate explorative surgical approach.

scholarly journals Homecare for sick family members while waiting for medical help during the 2014-2015 Ebola outbreak in Sierra Leone: a mixed methods study

2020 ◽  
Vol 5 (7) ◽  
pp. e002732
Author(s):  
Kirsten Schmidt-Hellerau ◽  
Maike Winters ◽  
Padraig Lyons ◽  
Bailah Leigh ◽  
Mohammad B Jalloh ◽  
...  
Keyword(s):  
Sierra Leone ◽  
Disease Transmission ◽  
Household Survey ◽  
Population Level ◽  
Protective Measure ◽  
Structured Interviews ◽  
Specific Knowledge ◽  
Protective Measures ◽  
Practical Advice ◽  
Sick Person

IntroductionCaring for an Ebola patient is a known risk factor for disease transmission. In Sierra Leone during the outbreak in 2014/2015, isolation of patients in specialised facilities was not always immediately available and caring for a relative at home was sometimes the only alternative. This study sought to assess population-level protective caregiving intentions, to understand how families cared for their sick and to explore perceived barriers and facilitators influencing caregiving behaviours.MethodsData from a nationwide household survey conducted in December 2014 were used to assess intended protective behaviours if caring for a family member with suspected Ebola. Their association with socio-demographic variables, Ebola-specific knowledge and risk perception was analysed using multilevel logistic regression. To put the results into context, semi-structured interviews with caregivers were conducted in Freetown.ResultsEbola-specific knowledge was positively associated with the intention to avoid touching a sick person and their bodily fluids (adjusted OR (AOR) 1.29; 95% CI 1.01 to 1.54) and the intention to take multiple protective measures (AOR 1.38; 95% CI 1.16 to 1.63). Compared with residing in the mostly urban Western Area, respondents from the initial epicentre of the outbreak (Eastern Province) had increased odds to avoid touching a sick person or their body fluids (AOR 4.74; 95% CI 2.55 to 8.81) and to take more than one protective measure (AOR 2.94; 95% CI 1.37 to 6.34). However, interviews revealed that caregivers, who were mostly aware of the risk of transmission and general protective measures, felt constrained by different contextual factors. Withholding care was not seen as an option and there was a perceived lack of practical advice.ConclusionsEbola outbreak responses need to take the sociocultural reality of caregiving and the availability of resources into account, offering adapted and acceptable practical advice. The necessity to care for a loved one when no alternatives exist should not be underestimated.

scholarly journals Tracheoinnominate Artery Fistula Formation in a Child with Long-Term Tracheostomy Dependence

2018 ◽  
Vol 08 (02) ◽  
pp. 096-099
Author(s):  
Jigar Chauhan ◽  
James Hertzog ◽  
Shirley Viteri ◽  
Nicholas Slamon
Keyword(s):  
Tracheostomy Tube ◽  
Tube Placement ◽  
Fistula Formation ◽  
Age Group ◽  
Pediatric Age ◽  
Pediatric Age Group ◽  
Hemorrhagic Event ◽  
Sentinel Events ◽  
High Index Of Suspicion

AbstractWe report a fatal tracheoinnominate artery fistula (TIF) in a 13-year-old female patient with long-term tracheostomy tube dependence due to chronic respiratory failure. Thirteen years after placement of her tracheostomy tube, the patient experienced two separate episodes of sentinel bleeding prior to a fatal hemorrhagic event. Diagnostic evaluation after the sentinel events was mostly nonconclusive. This case highlights the risk of TIF in pediatric age group, even years after initial tracheostomy tube placement, and the need for a high index of suspicion for TIF when children present with unexplained tracheal bleeding.

scholarly journals Penetrating Bladder Trauma: A High Risk Factor for Associated Rectal Injury

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
B. M. Pereira ◽  
L. O. Reis ◽  
T. R. Calderan ◽  
C. C. de Campos ◽  
G. P. Fraga
Keyword(s):  
Injury Severity ◽  
Foley Catheter ◽  
Gunshot Wounds ◽  
Rectal Injury ◽  
Macroscopic Hematuria ◽  
Average Systolic Blood Pressure ◽  
Bladder Trauma ◽  
High Risk Factor ◽  
Bladder Injuries ◽  
Rectal Injuries

Demographics and mechanisms were analyzed in prospectively maintained level one trauma center database 1990–2012. Among 2,693 trauma laparotomies, 113 (4.1%) presented bladder lesions; 51.3% with penetrating injuries (n=58); 41.3% (n=24) with rectal injuries, males corresponding to 95.8%, mean age 29.8 years; 79.1% with gunshot wounds and 20.9% with impalement; 91.6% arriving the emergence room awake (Glasgow 14-15), hemodynamically stable (average systolic blood pressure 119.5 mmHg); 95.8% with macroscopic hematuria; and 100% with penetrating stigmata. Physical exam was not sensitive for rectal injuries, showing only 25% positivity in patients. While 60% of intraperitoneal bladder injuries were surgically repaired, extraperitoneal ones were mainly repaired using Foley catheter alone (87.6%). Rectal injuries, intraperitoneal in 66.6% of the cases and AAST-OIS grade II in 45.8%, were treated with primary suture plus protective colostomy; 8.3% were sigmoid injuries, and 70.8% of all injuries had a minimum stool spillage. Mean injury severity score was 19; mean length of stay 10 days; 20% of complications with no death. Concomitant rectal injuries were not a determinant prognosis factor. Penetrating bladder injuries are highly associated with rectal injuries (41.3%). Heme-negative rectal examination should not preclude proctoscopy and eventually rectal surgical exploration (only 25% sensitivity).

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