Symptomatic Extraperitoneal Bladder Perforation Following Transurethral Bladder Surgery: Imaging with CT Urography

Abstract

An 80 year-old man presented to his primary care physician with painless gross hematuria. He reported having intermittent episodes of pink urine containing small clots for about three months. He was initially treated with a single course of ciprofloxacin for presumed urinary tract infection. His symptoms did not improve with antibiotic therapy and he was then referred to our institution for a computed tomography (CT) urogram. CT urogram showed a 4 x 3.6 centimeter (cm) infiltrating solid mass along the left lateral posterior wall of the urinary bladder ( Figure-1). Tumor also extended along the bladder dome. Prostate enlargement and bladder diverticula were also present. He was referred to the urology service and subsequently underwent transurethral resection of bladder tumor (TURBT) with fulguration. No intraoperative complications were noted and he returned to the recovery room in satisfactory condition on continuous bladder irrigation. Pathologic examination revealed a 5 cm transitional cell carcinoma with high grade growth pattern invading the deep muscular layer.On postoperative day one, the patient reported abdominal pain and general discomfort. Physical exam revealed a grossly distended abdomen which was tender to palpation with positive guarding and decreased bowel sounds. He

Nuclear medicine and the emergency department patient: an illustrative case-based approach

“…Currently, 1-year survival rates for renal grafts are 80 % for mismatched transplants from deceased donor, 90 % for nonidentical living donors and 95 % for HLA-matched grafts [42][43][44]. The half-life of grafts from living related donors ranges between 13 and 24 years, depending on the match [42][43][44][45][46][47].…”

“…ATN is caused by prolonged ischemia, which is more common in cadaveric grafts, and will resolve spontaneously in 2 weeks [42][43][44][45][46][47][48][49][50][51]. On a Tc99m MAG3 study, the graft will demonstrate normal blood flow, prolonged parenchymal retention of the tracer and delayed cortical transit of tracer into the collecting system.…”