A Case of A 15-Year Old with Perforated Gallbladder Type II Secondary To Acute Acalculous Cholecystitis, Severe Secondary to Typhoid Fever with Bile Peritonitis, in Sepsis

Typhoid fever is one of the most common enteric fever in low to middle income countries. In the pediatric population, it is a rare cause of acalculous cholecystitis in which one of the dreaded complication is gall bladder perforation. This was a case of a 15-year-old male with 1-month history of intermittent undocumented fever, anorexia and weight loss. The patient presented with signs of pancytopenia and abdominal examination revealed acute abdomen. Patient was optimized and prepared for surgery. Intraoperative findings revealed Type II gall bladder perforation with bile peritonitis, and patient underwent exploratory laparotomy, cholecystectomy, lavage, Jackson-Pratt drain. The sepsis eventually resolved postoperatively, and the patient was discharged. Preoperative diagnosis in patients with gall bladder perforation is often challenging and sophisticated, due to its rarity. However, it should be considered as one of the differential diagnoses in pediatric patients presenting with atypical history of abdominal pain. At present, there are no specific guidelines in the management of complications such as gall bladder perforation in patients with typhoid fever. Therefore, early diagnosis and immediate surgical intervention of gall bladder perforation are of prime importance in the successful outcomes of these patients, given the high morbidity and mortality associated with this condition.

The Intraoperative Use of a Portable Cone-Beam Computed Tomography System for the Diagnosis of Intraperitoneal Bladder Perforation

Background. Intraoperative imaging for endourologic procedures is generally limited to single-plane fluoroscopic X-ray. The O-arm™ is a mobile cone-bean CT scanner that may have applications in urologic surgeries. Case Presentation. We present a case of an 85-year-old male with radiation cystitis and recurrent gross hematuria who was identified to have a bladder perforation on cystoscopy during emergent clot evacuation. Single-view fluoroscopic evaluation was inconclusive as to whether an intraperitoneal bladder perforation occurred. A portable cone-beam CT scan was used to acquire a 3-D CT cystogram, which demonstrated intraperitoneal contrast extravasation, confirming the diagnosis of an intraperitoneal bladder perforation. Conclusion. We report the first use of a portable cone-beam CT scanner to perform an intraoperative CT cystogram to diagnose an intraperitoneal bladder perforation and guide surgical management.

1100 A Closed Loop Audit Comparing Admission Rates Post Transurethral Resection of Bladder Tumour (TURBT) Before and After Day Case Procedure Was Made the Standard Goal

Aim To assess the impact of making day case TURBT the standard goal. Method We performed a closed loop audit on the effect of listing all TURBTs as day case from the 1st December 2019. Data was collected retrospectively on all TURBTs from December 2018-March 2019, and from December 2019-March 2020 after implementing the change in protocol. Data collected included patient demographics, procedure and admission details, complications, and readmission rates. Results In total, 133 resections were included. Prior to the change in protocol, 36% of TURBTs were performed as day case. Of those admitted, 74% were due to haematuria, and 2% were planned. 8% were readmitted within 28 days and required urology input. There was 12% readmission rate overall. The rate of bladder perforation was 3.8%. Post intervention, 64% of all TURBTs were performed as day case. 82% of admissions were due to haematuria, and 14% were planned. The rate of bladder perforation remained low at 1.6%, and readmission rate was 3% with no urology input required. Conclusions TURBT is the standard endoscopic procedure for the diagnosis, grading and removal of bladder tumours. The use of day case surgery pathways has been emphasised to help reduce lengths of stay and streamline patient care. The British Association of Day Surgery (BADS) recommends that 60% of TURBTs could be performed as a day case procedure. This study shows that this recommendation can be exceeded through a simple and low-cost intervention, whilst maintaining a low complication rate.