Cystectomy: A Catastrophic Complication of Herniorrhaphy

Abstract

Injury to the bladder is a known complication of inguinal herniorrhaphy. Infants less than 6 months old may be more at risk because the medial aspect of indirect inguinal hernia sacs are associated closely with the wall of bladder ("bladder ears"). We report 2 cases of almost complete excision of the bladder during routine herniorrhaphy. In 1 patient bilateral ureteroileocecoplasty provided a course of management free of complication.

Anatomical basis of inguinal surgery in children

“…Special care must be taken to avoid tearing of the fibers of the internal oblique and abdominal transverse for the following reasons : 1) risk of opening the peritoneum; 2) creation of a weak point possibly leading to secondary direct hernia (Postlethwait 1971, Viidik 1980; 3) risk of off-track dissection causing serious bladder injury (Redmann et at. 1985).…”

Ileal patch graft used to repair a bladder injured during repair of an abdominal wall hernia

“…When primary closure is impossible, cystoplasty becomes necessary, but such cases are rare. Only two reports of children who required primary intestinal cystoplasty for iatrogenic bladder injury have been published [2,3]. The diagnoses in both cases were inguinal hernia, and primary cystoplasty was attempted to prevent contraction of the bladder in the future.…”

“…However, in the presence of heavy irradiation or multiple laparotomies, it loses elasticity, and primary closure is not possible. For such cases, cystoplasty using a segment of bowel is necessary [2,3]. To our knowledge, however, there has been no report of a primary cystoplasty for an accidental bladder injury in an adult patient.…”

Bladder rupture after inguinal herniotomy

“…Primary closure seems to be the easiest procedure, but results in a small bladder with VUR causing an unresolved ordeal for the child. Immediate ileocecoplasty as proposed by Redman et al, which provides a larger capacity, could be an attractive alternative procedure [3]. However, if the child grows up with a bladder capacity that increases year by year and the VUR improves yearly, it may prove worthwhile to follow up with simple primary closure.…”