Intraperitoneal Urinary Bladder Rupture as a Cause of Pneumoperitoneum

The most common cause of pneumoperitoneum in trauma patients is hollow viscus injury; however, in patients with pneumoperitoneum on imaging and normal hollow viscus during the laparotomy, other rare causes of pneumoperitoneum like intraperitoneal urinary bladder rupture should be ruled out. Urinary bladder can rupture either extraperitoneally or intraperitoneally or both. Rupture of the urinary bladder is commonly seen in patients with abdominal trauma; however, pneumoperitoneum is usually not seen in patients with traumatic bladder rupture. Intraperitoneal bladder rupture is usually due to the sudden rise in intra-abdominal pressure following abdominal or pelvic trauma. However, it is a rare cause of pneumoperitoneum and is managed by surgical repair. We present a case of blunt trauma abdomen with pneumoperitoneum due to isolated intraperitoneal bladder rupture who was managed by exploratory laparotomy and primary repair of the urinary bladder.

Features of the installation of a suprapubic cystostomy for laparoscopic treatment of patients with intraperitoneal bladder rupture

INTRODUCTION: In closed intraperitoneal bladder trauma, an alternative to laparotomy is laparoscopy. The rupture is closed with endoscopic sutures, and the bladder is drained with a urethral catheter. In the literature, the issue of the placement of a trocar cystostomy during laparoscopic treatment of patients with intraperitoneal bladder ruptures requiring prolonged drainage is insufficiently covered. PURPOSE OF THE STUDY: Determination of the optimal trocar cystostomy method during laparoscopic treatment of intraperitoneal bladder rupture. MATERIALS AND METHODS: Trocar cystostomy was performed in 8 patients with intraperitoneal bladder ruptures, among whom 7 had concomitant diseases of the prostate gland, and 1 had urethral stricture. Trocar cystostomy during laparoscopic surgery was performed in three different ways. Results. In the first method, the rupture of the bladder was initially sutured. Then, through the urethral catheter, the bladder was filled with saline. A trocar cystostomy was inserted through the suprapubic region. The second method consisted in the installation of a trocar cystostomy under the control of a laparoscope even before the suturing of the bladder rupture. In the third method proposed by us (patent No. 2592023), a Foley-type catheter with a balloon capacity of at least 200 ml was inserted into the abdominal cavity through the laparoscopic port. A catheter was inserted from the abdomen through an intraperitoneal rupture into the bladder. Inside the bladder, the catheter balloon was filled with saline. Then, through the suprapubic region, the anterior abdominal wall, the bladder and the inflated balloon of the catheter were pierced layer by layer with a trocar. Another catheter was inserted through the trocar into the bladder. After removal of the catheter with a ruptured balloon, the intraperitoneal rupture of the bladder was sutured. FINDINGS: According to the results of the study, the third method of inserting a trocar cystostomy turned out to be the most optimal and safe.

Spontaneous urinary bladder perforation: An unusual presentation of well-differentiated papillary peritoneum mesothelioma

Introduction: Well-differentiated papillary mesothelioma (WDPM) is a very rare neoplasm. Most of WDPM are asymptomatic and are often incidentally detected during surgery. This report describes a case of WDPM of the peritoneum unexpectedly diagnosed in a male with a spontaneous intraperitoneal bladder rupture. Case presentation: A 65-year-old male presented to our Emergency Department in November 2019 with a two-day history of anuria, abdominal pain, distention, and sepsis. The CT scan reported a large amount of extra and intraperitoneal free fluid. The CT cystogram showed bladder perforations on the dome and on the left lateral wall which was repaired through exploratory laparotomy. Intraoperatively, we encountered extensive suppurative peritonitis with large fibrino-purulent exudation. The purulent perivesical peritoneum was dissected and sent for histopathological examination which unexpectedly resulted in WDPM of the peritoneum. Conclusion: Although we can’t affirm with certainty, this case would seem to suggest that WDPM had played a role in patient’s clinical presentation. However, further research is necessary to draw stronger conclusion.