Do you think of gangrenous gallbladder following blunt trauma abdomen? a rare case report

Isolated gangrenous gallbladder secondary to blunt trauma abdomen (BTA) is the rarest entity comes with great challenge due to low incidence. Gallbladder injury was reported to be between 1.9%-2.1% of all abdominal trauma, out of it, gall bladder rupture seen in <1%. Till date only one case report has been published. Clinical presentation of gallbladder injury is variable, resulting in a delay in diagnosis and treatment. This case report describes a significant mechanism of blunt force injury resulting in an isolated gangrenous gallbladder as it is a relatively well-protected organ; consequently, its gangrenous following blunt abdominal injury is rare and usually associated with other visceral injuries. Almost all gallbladder injuries following blunt trauma are associated with other significant intra-abdominal injuries and in the setting of acute trauma. We recommend an open procedure to facilitate a detailed exploration to exclude associated injuries. We report a case of a healthy 23years old adult male who sustained isolated gangrenous gallbladder following BTA who sustained injury following fall from riding a two wheeler motor cycle. We recommend an open cholecystectomy procedure to facilitate a detailed exploration to exclude associated injuries and has a good outcome.

A Rare Case of Recurrent Generalized Peritonitis Caused by Spontaneous Urinary Bladder Rupture after Radiotherapy: A Case Report and Literature Review

Since generalized peritonitis is a fatal disease, accurate diagnosis and treatment are important. In this paper, we report a case of recurrent generalized peritonitis associated with spontaneous urinary bladder rupture (SBR). A 65 year old woman, who underwent radiotherapy 21 years prior, was diagnosed with generalized peritonitis. Although the cause of the generalized peritonitis could not be identified, the patient recovered with conservative treatment in short period. However, recurrent episodes of generalized peritonitis occurred four times. We diagnosed the patient with urinary ascites due to SBR, based on a history of radiotherapy and dysuria. No recurrence of generalized peritonitis had occurred after accurate diagnosis and treatment with long-term bladder catheter placement. Since SBR often occurs as a late complication after radiotherapy, it is difficult to diagnose SBR, which leads to delayed treatment. This case and literature review of similar cases suggest that the information of the following might be helpful in the diagnosis of SBR: (i) history of recurrent generalized peritonitis, (ii) pseudo-renal failure, (iii) history of radiotherapy, (iv) dysuria, and (v) increase or decrease of ascites in a short period. It is important to list SBR in the differential diagnosis by knowing the disease and understanding its clinical features. This case and literature review will serve as a reference for future practices.

Spontaneous Rupture of Urinary Bladder: Two Case Reports and Review of Literature

Objectives: Spontaneous rupture of the urinary bladder (SRUB) is extremely rare and might be misdiagnosed, leading to a high mortality rate. The current study aimed to identify the cause, clinical features, and diagnosis strategy of SRUB.Methodology: We presented a case report for two women (79 and 63 years old) misdiagnosed with acute abdomen and acute kidney injury, respectively, who were finally confirmed to have SRUB by a series of investigations and exploratory surgery. Meanwhile, literature from multiple databases was reviewed. PubMed, the Chinese National Knowledge Infrastructure (CNKI), the Chinese Biological Medical Literature Database (CBM), WANFANG DATA, and the Chongqing VIP database for Chinese Technical Periodicals (VIP) were searched with the keywords “spontaneous bladder rupture” or “spontaneous rupture of bladder” or “spontaneous rupture of urinary bladder.” All statistical analyses were conducted using SPSS 20.0 software.Results: A total of 137 Chinese and 182 English literature papers were included in this article review. A total of 713 SRUB patients were analyzed, including the two patients reported by us. The most common cause of SRUB was alcohol intoxication, lower urinary tract obstruction, bladder tumor or inflammation, pregnancy-related causes, bladder dysfunction, pelvic radiotherapy, and history of bladder surgery or bladder diverticulum. Most cases were diagnosed by exploratory laparotomy and CT cystography. Patients with extraperitoneal rupture could present with abdominal pain, abdominal distention, dysuria, oliguria or anuria, and fever. While the main symptoms of intraperitoneal rupture patients could be various and non-specific. The common misdiagnoses include acute abdomen, inflammatory digestive disease, bladder tumor or inflammation, and renal failure. Most of the patients (84.57%) were treated by open surgical repair, and most of them were intraperitoneal rupture patients. Overall, 1.12% of patients were treated by laparoscopic surgery, and all of them were intraperitoneal rupture patients. Besides, 17 intraperitoneal rupture patients and 6 extraperitoneal rupture patients were treated by indwelling catheterization and antibiotic therapy. Nine patients died of delayed diagnosis and treatment.Conclusions: SRUB often presents with various and non-specific symptoms, which results in misdiagnosis or delayed treatment. Medical staff noticing abdominal pain suggestive of peritonitis with urinary symptoms should be suspicious of bladder rupture, especially in patients with a history of bladder disease. CT cystography can be the best preoperative non-invasive examination tool for both diagnosis and evaluation. Conservative management in the form of urine drainage and antibiotic therapy can be used in patients without severe infection, bleeding, or major injury. Otherwise, surgical treatment is recommended. Early diagnosis and management of SRUB are crucial for an uneventful recovery.

Spontaneous rupture of bladder diverticulum: a case report of non-traumatic extraperitoneal urinary bladder rupture managed with surgical intervention

Spontaneous extraperitoneal bladder rupture is a rare urology emergency. Most of the extraperitoneal urinary bladder rupture cases were management conservatively. To my best knowledge, there was very few reported about outcome of surgical management for spontaneous extraperitoneal urinary bladder rupture. Herein we shared our experience treating a 84 year old male who first presented with gross hematuria and frequent clots retention. Later he developed septic shock and peritonism which prompted us to do an urgent CT and found out the cause of his acute abdomen. The dilemma we faced to go in for operation was explained and patient had a turbulent post-operative time and he eventually succumbed to death due to various factors. Spontaneous extraperitoneal urinary bladder rupture is a rare cause of acute abdomen and prompt diagnosis and management can produce best clinical outcome.