Significant extravasation does not preclude conservative management of spontaneous perforation of the augmented bladder

Abstract

Abstract Background Perforation of the augmented bladder is a serious and well-known complication of bladder augmentation. The traditional treatment has been emergent surgical exploration and repair of the bladder perforation due to the risk of peritonitis, sepsis and mortality. Some studies have reported successful conservative management by maximizing bladder drainage in patients with stable hemodynamics and limited peritoneal extravasation. Herein, we report the successful conservative management of spontaneous perforation of augmented bladder in a 5-year-old boy with exstrophy-epispadias complex following epispadias repair with significant extravasation. Case presentation A 5-year-old boy had augmentation ileocystoplasty to facilitate repair of failed bladder exstrophy closure. Modified penile disassembly was used for epispadias repair with a transurethral catheter draining the bladder. The patient presented on postoperative day 2 with a non-draining catheter, fever, repeated vomiting and abdominal distension. Leukocytosis and elevated creatinine were evident on laboratory work-up. CT cystogram confirmed the diagnosis of spontaneous perforation of the augmented bladder with significant intraperitoneal extravasation. Conservative management was successful by inserting a suprapubic catheter and an intraperitoneal drain. The patient subsequently underwent creation of Mitrofanoff appendicovesicostomy and bladder neck closure to achieve dryness without recurrence of perforation on follow-up. Conclusions Perforation of the augmented bladder can be managed conservatively even in the presence of significant peritoneal extravasation by maximizing bladder drainage and insertion of an image-guided intraperitoneal drain.

Keywords

• Bladder augmentation
• Perforation
• Conservative
• CT cystogram