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[Post-traumatic complication of trans-appendiceal cystostomy: urinary peritonitis]
J L Landry1, R Dubois, P Chaffange
1Service d'Urologie pédiatrique, Hôpital Edouard Herriot, Lyon, France.
Insights
Bladder rupture is a rare complication following Mitrofanoff urinary diversion in children. Prompt surgical repair is crucial, highlighting the need for careful patient selection to minimize risks.
Area of Science:
- Pediatric Surgery
- Urology
Background:
- Transappendicular urinary diversion, such as the Mitrofanoff procedure, is utilized in pediatric urology.
- This technique creates a channel for bladder management, often in cases of neurogenic bladder or other complex conditions.
Observation:
- Two pediatric cases of bladder rupture after Mitrofanoff urinary diversion are reported.
- One rupture occurred after abdominal trauma 4 months post-operation; the second followed self-catheterization 4 years post-operation.
Findings:
- Diagnosis was confirmed by clinical presentation and radiological imaging, including ultrasonography and cystography, revealing urinary peritonitis.
- Both patients underwent emergency surgical repair with successful postoperative outcomes.
Implications:
- Bladder rupture is a serious, albeit rare, complication necessitating urgent surgical intervention.
- Rigorous patient selection for Mitrofanoff diversion is essential, favoring increased bladder neck resistance over bladder neck closure to prevent such events.
Abstract:
Two children who had undergone a transappendicular urinary diversion (type Mitrofanoff) developed bladder rupture, one following abdominal trauma, 4 months after the operation and the other following traumatic self-catheterization at 4 years. The clinical history and standard radiological examinations (ultrasonography, cystography) confirmed the diagnosis of urinary peritonitis. Emergency surgical repair was possible in both cases with an uneventful postoperative course. This serious and rare complication requires emergency surgery and justifies rigorous selection of children suitable for this type of diversion giving preference to increased bladder neck resistance over bladder neck closure.