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IndicationsSpontaneous rupture of the bladder is a rare occurrence and therefore unlikely to be diagnosed pre-operatively. The majority of ruptures are due to blunt trauma or iatrogenic causes [ 1,2]. Pre-operative diagnosis can be made in such cases and suitable patients selected for laparoscopic repair, bringing the advantages of minimal access surgery to these patients.We report two cases of intraperitoneal rupture of the bladder, one spontaneous and the other of traumatic,' non-iatrogenic cause; both were repaired laparoscopically. The first patient was a 22-year-old lady who was admitted in August 1992, with a 1 week history of painful micturition culminating in severe abdominal pain. She had generalized peritonitis and catheterization revealed blood-stained urine. Emergency diagnostic laparoscopy performed after resuscitation revealed 1.5 L of bloody ascitic fluid and a 2 cm rupture at the dome of the bladder. Biopsy revealed acute innammation with perforation.The second patient was a 54-year-old man who presented with abdominal pain and an inability to pass urine following a car accident. There was no evidence of pelvic fracture or any other intra-abdominal injury. An urgent cystogram revealed an intra-peritoneal bladder rupture. Emergency diagnostic laparoscopy revealed a 3 cm rupture at the dome of the bladder with bloodstained urine in the peritoneal cavity. MethodUnder general anaesthesia, three working ports were placed a 5 mm port was sited above the suprapubic area and two other ports of 5 mm and 10 mm, at the same level as the sub-umbilical port on either side along the mid-clavicular line. The rupture was repaired laparoscopically with two layers of absorbable suture. The bladder was distended with 300 mL of saline to test for leaks. The peritoneal cavity was then lavaged thoroughly with saline before withdrawal of the ports and closure of the incisional wounds. 50Catheter drainage was continued for 1 week after the operation to allow adequate healing. No complications were encountered and there was little need for postoperative pain relief. Both patients recovered quickly with the second one returning to work after 2 weeks. The first patient had total bladder failure and was taught intermittent self-catheterization. Comparison with other methodsIn accodance with our practice, we performed a diagnostic laparoscopy to confirm the diagnosis and exclude other pathology or injury. Using established laparoscopic suturing techniques, we repaired the rupture as for open methods. Similar laparoscopic repairs have been reported for iatrogenic perforation of the bladder [2] and perforated peptic ulcers [3]. If laparoscopic surgery is not available, the only other surgical option would be conventional laparotomy followed by open repair of the bladder perforation. Advantages and disadvantagesWe feel that intraperitoneal rupture of the bladder from any cause can be safely repaired laparoscopically avoiding the problems associated with a large abdominal incision. The benefits of minimal access surgery to the pa...

Centerline extraction and segmentation of the spinal cord--an intensity varying and elliptical curvilinear structure under strong neighboring disturbance are extremely challenging. This study proposes the gradient competition anisotropy technique to perform spinal cord centerline extraction and segmentation. The contribution of the proposed method is threefold--1) The gradient competition descriptor compares the image gradient obtained at different detection scales to suppress neighboring disturbance. It reliably recognizes the curvilinearity and orientations of elliptical curvilinear objects. 2) The orientation coherence anisotropy analyzes the detection responses offered by the gradient competition descriptor. It enforces structure orientation consistency to sustain strong disturbance introduced by high contrast neighboring objects to perform centerline extraction. 3) The intensity coherence segmentation quantifies the intensity difference between the centerline and the voxels in the vicinity of the centerline. It effectively removes the object intensity variation along the structure to accurately delineate the target structure. They constitute the gradient competition anisotropy method which can robustly and accurately detect the centerline and boundary of the spinal cord. It is validated and compared using 25 clinical datasets. It is demonstrated that the proposed method well suits the applications of spinal cord centerline extraction and segmentation.