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Delayed bladder rupture after augmentation enterocystoplasty
H G Rushton1, J R Woodard, T S Parrott
1Division of Urology, Emory University School of Medicine, Atlanta, Georgia.
Insights
Delayed bladder perforation after enterocystoplasty in children with spina bifida is a severe complication. Early diagnosis and intervention are crucial to prevent life-threatening peritonitis and sepsis.
Area of Science:
- Pediatric Surgery
- Urology
- Gastroenterology
Background:
- Augmentation enterocystoplasty is a procedure to enlarge the bladder, often for children with spina bifida and neuropathic bladders.
- Undiversion procedures using tubular colonic segments are common in managing these complex cases.
- Intermittent self-catheterization is a standard management for patients post-enterocystoplasty.
Observation:
- Four cases of delayed bladder perforation with peritonitis following augmentation enterocystoplasty in children with spina bifida are presented.
- Patients had undergone enterocystoplasty with a tubular colonic segment and managed with intermittent self-catheterization.
- The time from surgery to presentation varied from 6 months to 3 years.
Findings:
- Diagnosis was delayed in all reported cases.
- Cystogram studies were normal in 3 patients despite evidence of urine extravasation during surgical exploration.
- One patient developed generalized sepsis and respiratory distress syndrome, ultimately succumbing to the complication.
Implications:
- This case series highlights the potential for delayed, life-threatening complications after augmentation enterocystoplasty.
- The findings underscore the importance of high clinical suspicion for bladder perforation, even with normal imaging.
- Improved diagnostic strategies and timely surgical intervention are critical for improving outcomes in these vulnerable patients.
Abstract:
Delayed bladder perforation with peritonitis following augmentation enterocystoplasty in children with spina bifida is a serious and potentially life-threatening complication. Our experience with 4 such cases is presented. All patients had spina bifida with a neuropathic bladder and they had undergone augmentation enterocystoplasty with a tubular colonic segment of large bowel as part of an undiversion procedure. All patients were being managed with intermittent self-catheterization. The interval from augmentation enterocystoplasty until presentation ranged from 6 months to 3 years. Diagnosis was delayed in all cases, including 3 in which cystogram studies were normal despite findings of extravasation of urine at exploration. In 1 patient generalized sepsis developed with the respiratory distress syndrome and, subsequently, she died.