Delayed Bladder Rupture after Augmentation Enterocystoplasty

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.

Augmentation cystoplasty

“…Mucus provides a protective layer to the bowel epithelium in its natural environment, and an intact layer of mucus may be important in protecting the bowel patch from contact with urinary carcinogens and other substances [112]. However, mucus accumulation can predispose to UTI, stone formation and BOO, and can occasionally contribute to bladder perforation, especially in patients with neuropathy [113,114]. Oral ranitidine can reduce the amount of mucus produced [115] and acetylcysteine washouts help to dissolve excess mucus [116].…”

Long-Term Sequela of Pediatric Bladder Reconstruction

“…Reported rates of bladder perforation following augmentation range between 6-13% (9,22,(46)(47)(48)(49). Perforation occurs due to increased intravesical pressure, which may result from chronic bladder over-distention, chronic infection, traumatic catheterization, and ischemic necrosis of the intestinal segment used for the augmentation (50)(51)(52)(53)(54)(55)(56). Bladder perforation usually demands exploratory laparotomy with externalization of VPS (if present), to reduce the risk of CNS infections.…”

Analysis of Anastomotic Line Perfusion with Fluorescent Molecular Imaging After Augmentation Ileocystoplasty in Open and Robot-Assisted Laparoscopic Surgery

“…The most important and a potentially lethal complication is bladder perforation. [5][6][7][8] The etiology of bladder perforation is not exactly known. However, some authors have suggested that it is related to ischemic changes at the ileal-anastomotic line.…”