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Laparoscopic repair of intra-abdominal bladder perforation in preschool children
Aniruddh V Deshpande1, Peter Michail2, Parshotam Gera3
1Department of Paediatric Surgery, John Hunter Children's Hospital, Newcastle, Australia.
Insights
Seat and lap belts can cause rare intraperitoneal bladder ruptures in young girls. Laparoscopic repair is a safe and effective treatment option for this pediatric injury.
Area of Science:
- Pediatric Surgery
- Urology
- Minimally Invasive Surgery
Background:
- Intraperitoneal bladder rupture is an uncommon pediatric injury.
- Increased use of seat and lap belts may be contributing to a rise in these injuries.
- Laparoscopic repair for this specific injury in children has not been previously reported.
Observation:
- Two preschool-aged girls presented with isolated intraperitoneal bladder perforations secondary to seat and lap belt trauma.
- Diagnosis was confirmed via contrast computed tomography and cystogram.
- Both patients had significant free peritoneal fluid, indicating bladder rupture.
Findings:
- A successful laparoscopic repair was achieved using a three-port technique with delayed absorbable sutures and intracorporeal suturing.
- Meticulous peritoneal lavage was performed to minimize urinary peritonitis.
- Post-operative cystograms at day 7 confirmed no urinary leaks.
Implications:
- Young girls are identified as a risk group for intraperitoneal bladder injuries from lap belt use.
- Laparoscopic repair is a feasible and safe surgical approach for isolated bladder ruptures in children.
- This technique offers a minimally invasive option for treating pediatric bladder trauma, provided other life-threatening injuries are excluded.
Abstract:
Intraperitoneal bladder rupture is uncommon in very young children, but its incidence may increase with increasing use of seat and lap belts. To the best of our knowledge, there are no prior reports of laparoscopic repair of this injury in children. We describe two recent cases and discuss useful technical points that facilitate a successful laparoscopic repair. Both our patients were preschool age girls who sustained seat and lap belt injuries. Contrast computed tomography scan suggested a large amount of free peritoneal fluid and cystogram confirmed intraperitoneal bladder perforation (isolated injury). The injury was repaired using delayed absorbable sutures and intracorporeal suturing (continuous in 1, interrupted in 1) using a 3 port laparoscopic technique. Meticulous peritoneal lavage was carried out to minimise urinary peritonitis and the bladder as well as the peritoneal cavity were drained. Check cystograms (day 7) revealed no leaks. Young girls appear to be at risk of intraperitoneal bladder injuries following lap belt injuries. After exclusion of life-threatening injuries and concurrent abdominal injuries which need rapid control or preclude pneumoperitoneum, a laparoscopic repair can be safely performed.
