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Intraperitoneal bladder rupture in a 1 year old: A very unusual accident
Amar Shah, Anirudh Shah
Amardeep Multispecialty Children Hospital and Research Centre, Ahmedabad, Gujarat, India
| Date of Submission | 03-Sep-2021 |
| Date of Acceptance | 30-Nov-2021 |
| Date of Web Publication | 11-Feb-2022 |
Correspondence Address:
Amar Shah,
Amardeep Multispecialty Children Hospital and Research Centre, 65, Pritamnagar Society, Near Government Ladies Hostel, Near Gujarat College, Ellisbridge, Ahmedabad - 380 006, Gujarat
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/jmas.jmas_287_21
Intraperitoneal bladder rupture is a rare event in the paediatric population. Road traffic accidents (RTA) and seat belt injuries are considered to be the main cause for the same. We report an interesting case of a 1-year-old girl who had a laparoscopic repair of intraperitoneal bladder tear following a non-RTA injury. This is the smallest child where intraperitoneal bladder rupture was repaired laparoscopically. This mechanism of injury-causing bladder rupture has also not been reported across world literature. The child was sleeping on the floor near the bed with her mother. The father who was sleeping on the bed accidentally fell onto this child. Imaging showed large amount of clear intraperitoneal fluid with no organ injury. Laparoscopy showed a 3.5 cm long tear on the posterior wall of the bladder. The tear was repaired using 3 mm instruments.
Keywords: Bladder rupture, child, intraperitoneal, laparoscopy
| ¤ Introduction | |  |
Bladder rupture is rare in children. It accounts for only 0.05%–2% of all pelvic trauma cases.[1] Most of the intraperitoneal bladder injuries have been reported to occur in road traffic accidents (RTA) and predominantly due to seat belt compression.[2] Because of the shallow pelvis in young children, the bladder appears intra-abdominal. This location of the bladder makes it more vulnerable to injury.[1] The present report is unique by the mechanism of injury causing the bladder to rupture. To the best of our knowledge, this is also the smallest reported child with intraperitoneal bladder rupture that has been repaired laparoscopically.
| ¤ Case Report | | |
Our patient is a 1-year-old female. She has an elder sister who is 6-year-old. Due to space crunch in the bedroom, the father and older daughter sleep on the bed, whereas the younger daughter (patient) and her mother sleep on the floor next to the bed. In the middle of the night, the father accidentally fell off the bed in his sleep onto the abdomen on the 1-year-old daughter [Figure 1]. There was no visible external injury and hence, no medical attention was sought. However, over the next 24 h, the mother noted that the child was anuric and gradually developed abdominal distention, irritability and refusal of feeds. Following this, medical attention was sought. Clinical examination showed the child to be afebrile and haemodynamically stable. She had generalised abdominal distention with free fluid. Ultrasound scan and a contrast-enhanced computed tomography scan showed intraperitoneal fluid with no major organ injury. A bladder catheter was inserted which drained no urine. In view of the history and findings, laparoscopy was planned. The child was placed supine with the monitor at the foot end. Three 3 mm ports were used. Camera was at the umbilical port and two working ports were placed on either side with a CO2 pressure of 10 mm Hg. At laparoscopy 800 ml of clear intraperitoneal free fluid was removed. Injury to the solid organs and bowel was excluded. Further examination revealed a 3.5 cm tear on the posterior bladder wall near the dome of the bladder [Figure 2]. This was repaired in single layer using 3-0 polyglactin continuous sutures. A tube drain was kept in the pelvis through the left-sided port. The post-operative course was uneventful. Feeds were commenced 6 h following surgery. The drain was removed on the 5th post-operative day and the child was discharged following removal of the bladder catheter on the 7th post-operative day.
| ¤ Discussion | | |
Blunt injury of the urinary bladder is well known and commonly seen in patients of RTA's with pelvic fractures.[1] The extraperitoneal tears may be managed conservatively with bladder drainage. However, surgery is recommended for intraperitoneal bladder tears.[3],[4] Bladder rupture is an uncommon occurrence in children. However when it does occur, it is commonly because of the location of the bladder. The mechanism of injury in our case was quite unusual and unheard of. Around midnight, the child's bladder would have been distended with urine. The sudden weight of an adult onto this distended bladder would have caused the bladder to rupture. Open surgery used to be the standard of care for intraperitoneal bladder tears. However, in hemodynamically stable children with no documented major organ injury laparoscopy should be the procedure of choice. It offers the advantage of a thorough evaluation of the intraabdominal viscera and complete clearance of any intraperitoneal collection. In our case laparoscopy also offered a very clear view of the injury and magnification to ensure a good watertight repair.
Review of the literature revealed only two reports involving four children who had laparoscopic repair of intraperitoneal bladder rupture.[5],[6] However, all these children were aged 3 years and above and the mechanism of injury was RTA. Ours is the smallest reported child to have an intraperitoneal bladder rupture following the most unusual mode of injury and also to have a laparoscopic repair of the same.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| ¤ References | | |
| 1. | Dokucu AI, Ozdemir E, Oztürk H, Otçu S, Onen A, Ciğdem K, et al. Urogenital injuries in childhood: A strong association of bladder trauma to bowel injuries. Int Urol Nephrol 2000;32:3-8.  |
| 2. | Stoddart A. Intraperitoneal bladder rupture and the wearing of rear seat-belts – A case report. Arch Emerg Med 1993;10:229-31. |
| 3. | Deibert CM, Glassberg KI, Spencer BA. Repair of pediatric bladder rupture improves survival: Results from the National Trauma Data Bank. J Pediatr Surg 2012;47:1677-81. |
| 4. | Matsui Y, Ohara H, Ichioka K, Terada N, Yoshimura K, Terai A. Traumatic bladder rupture managed successfully by laparoscopic surgery. Int J Urol 2003;10:278-80. |
| 5. | Deshpande AV, Michail P, Gera P. Laparoscopic repair of intra-abdominal bladder perforation in preschool children. J Minim Access Surg 2017;13:63-5. |
| 6. | Karadag CA, Tander B, Erginel B, Demirel D, Bicakci U, Gunaydin M, et al. Laparoscopic repair in children with traumatic bladder perforation. J Minim Access Surg 2016;12:292-4. |
[Figure 1], [Figure 2]
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