A Case of Idiopathic Recurrent Spontaneous Bladder Rupture

Background. A female patient presented four years following spontaneous bladder rupture with a recurrent spontaneous bladder rupture. Summary. Urinary bladder rupture is a condition usually caused by trauma or surgical instrumentation. Spontaneous bladder rupture is a much more uncommon condition and is associated with intoxication, radiation, stricture, or neurogenic bladder. We describe a case of a 40-year-old woman with a history of three caesarian sections with an idiopathic recurrent spontaneous bladder rupture. Originally, she presented with one day of worsening severe abdominal pain. CT showed possible ischemic bowel. She was taken to the operating room (OR) and found to have a bladder rupture. This was repaired, and she did well postoperatively. Four years later, she presented to the emergency department (ED) with one week of worsening abdominal pain that became severe acutely. Given that she had a similar issue four years prior the patient was suspicious, her bladder was again ruptured. CT cystogram showed contrast extravasation into the peritoneum. The patient was taken urgently to the operating room for an open repair of the bladder rupture. She did well following the procedure. Conclusion. Spontaneous bladder rupture is a surgical emergency and should be in the differential diagnosis of any patient with peritonitis with elevated creatinine and free intraperitoneal fluid. This diagnosis should especially be considered if the patient has a history pelvic radiation, neurogenic bladder, or intoxication. We submit that a history of multiple pelvic surgeries should be included in this list. CT cystogram is the diagnostic test of choice. Operative repair is generally the treatment for this condition.

Inflammatory bowel disease in patients with prostate cancer treated with radiation.

15 Background: Inflammatory bowel disease (IBD) has long been considered a risk factor for increased bowel toxicity from radiation therapy (RT); however, minimal evidence exists for patients with prostate cancer (PC) and IBD. Methods: The tumor registry was queried for patients with both IBD and PC from 2000-2010. A chart review was conducted for patients who received RT for PC. All patients carried the diagnosis IBD as defined by either Crohn’s disease or ulcerative colitis. RT specifics and radiation toxicity (acute and late) data were collected. Results: Eighteen patients met the inclusion criteria for PC and IBD diagnoses with radiation therapy treatment. Twelve were treated with external beam radiation therapy (EBRT), and 6 were treated with low dose rate (LDR) brachytherapy. Average length of follow-up was 12 years (median 9.54, range 0.42-19.9). Most patients had well controlled baseline bowel function on medical management. Twenty-two percent were in remission from IBD without any form of treatment; 56% were actively taking 5-ASA; 17% were prescribed prednisone; and 6% were taking Remicade. Sixty percent of patients (9/15) reported grade 0 (G0) diarrhea at baseline prior to radiation therapy. Forty percent (6/15) suffered grade 1 (G1) diarrhea at baseline. No baseline proctitis existed. Two patients reported ostomy prior to radiation. Following radiation treatment, 78% (14/18) of patients experienced G0 diarrhea while 22% (4/18) reported G1 diarrhea. No patients suffered from greater than G1 diarrhea. Sixty-seven percent (12/18), 17% (3/18) and 17% (3/18) of patients experienced G0, G1, and G2 proctitis, respectively. No patients suffered post-radiation stricture formation. All patients with G2 proctitis following RT received 3dCRT. Conclusions: No available published data explores RT for patients with PC and IBD. This retrospective review offers valuable insight into appropriate counseling for a rare patient subset. EBRT was associated with improvement in late G1 diarrhea rates. Grade 2 proctitis was only encountered among 3dCRT patients. No post-radiation stricture or ostomy placements occurred. Our findings suggest that IBD patients experience minimal toxicity with IMRT-based radiation therapy.

Radiation Stricture of the Biliary Ducts: An Emerging New Entity?

Two patients with stricture of the extrahepatic biliary tree are described. Both patients presented with a clinical picture of obstructive jaundice one to two years following radiotherapy for a malignant condition. As no recurrent tumour was detected in either of the patients the strictures were considered to be the result of radiation therapy. Bilio-enteric decompression was performed in both patients who are well at follow up one and ten years after the procedure.