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Delayed spontaneous rupture of augmented bladder in children: diagnosis with sonography and CT
1Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC.
Insights
Delayed spontaneous intraperitoneal rupture of augmented bladders is a risk. Sonography and CT are reliable for detecting free intraperitoneal fluid, aiding diagnosis when cystography is inconclusive.
Area of Science:
- Urology
- Radiology
- Pediatric Surgery
Background:
- Augmentation enterocystoplasty is increasingly used for small-capacity, noncompliant bladders.
- Delayed spontaneous intraperitoneal rupture of augmented bladders is a reported complication.
- Clinical signs of bladder rupture can be masked in spina bifida patients due to neurologic deficits.
Purpose of the Study:
- To evaluate diagnostic imaging modalities for delayed spontaneous intraperitoneal rupture of augmented bladders in spina bifida patients.
- To determine the reliability of sonography and CT in detecting extravasated urine.
Main Methods:
- Retrospective review of four spina bifida patients with delayed spontaneous rupture of augmented bladders.
- Imaging techniques included cystography, sonography, isotope cystography, and CT.
- Analysis of findings for detection of free intraperitoneal fluid.
Main Results:
- Cystography was abnormal in only one of the four cases.
- Sonography identified free intraperitoneal fluid in all four patients.
- CT scans also detected free intraperitoneal fluid in the two patients examined.
Conclusions:
- Enhanced cystography frequently fails to detect leakage from augmented bladders.
- Sonography and CT are reliable tools for identifying free intraperitoneal fluid.
- These imaging modalities significantly aid in diagnosing ruptured augmented bladders, especially when cystography is normal.
Abstract:
With the increasing use of augmentation enterocystoplasty to treat patients with small-capacity, noncompliant bladders, an increase in the number of cases of delayed spontaneous intraperitoneal rupture of the augmented bladder has been reported. Although patients with a ruptured bladder usually will have an acute abdomen, these clinical signs and symptoms may be masked in spina bifida patients because of their neurologic deficit. Cystography and sonography were performed in four spina bifida patients with delayed spontaneous rupture of an augmented bladder. One patient also had isotope cystography. Two patients were examined with CT. Cystographic findings were abnormal in only one case. Peritoneal fluid was identified sonographically in all four cases and also was seen in both CT studies. Our study reveals that enhanced cystography will frequently fail to show leakage from an augmented bladder. Sonography and CT are reliable in detecting free intraperitoneal fluid, a finding that can significantly aid in the diagnosis of ruptured bladder after enterocystoplasty. Therefore, cystography with normal findings must be followed by sonography or CT in order to detect extravasated urine.