Case Report: A Neocystostomy Perforation Presenting as a Gallstone

Area of Science:

• Urology
• Gastroenterology
• Surgical Case Reports

Background:

• Radical cystectomy with neobladder construction is a complex procedure for bladder cancer treatment.
• Orthotopic bladder substitution aims to restore urinary function but carries potential long-term risks.
• Acute cholecystitis is a common surgical emergency, typically involving gallbladder inflammation.

Observation:

• An 83-year-old male, 13 years post-neobladder surgery, presented with symptoms and imaging suggestive of acute cholecystitis.
• Emergent laparotomy revealed a perforated neobladder with stones in the gallbladder fossa, mimicking gallbladder disease.
• This unique presentation is the first reported instance of neobladder perforation masquerading as acute cholecystitis.

Findings:

• Neobladder perforation can occur long after initial surgery, presenting with atypical symptoms.
• Spilled neobladder contents (stones) in the gallbladder fossa can create a diagnostic challenge.
• The clinical and radiological presentation can be misleading, mimicking other acute abdominal conditions.

Implications:

• Clinicians must maintain a high index of suspicion for neobladder complications in patients with a history of bladder substitution.
• Delayed diagnosis of neobladder perforation can lead to significant morbidity.
• This case underscores the need for long-term surveillance and awareness of potential late complications following neobladder surgery.