以腹腔鏡修補腹部鈍挫外傷導致之腹膜內膀胱破裂：病例報告與文獻回顧

王世鋒

國泰綜合醫院 外科部 泌尿科

Laparoscopic repair of traumatic intraperitoneal urinary bladder rupture after bluntAbdominal trauma: Case report and literature review

Shih-Feng Wang

Division of Urology, Department of Surgery, Cathay General Hospital

Introduction: Urinary ladder rupture often occurs secondary to trauma or iatrogenic procedures. Blunt abdominal trauma results in intraperitoneal ruptures in patients with distended urinary bladder. Other associated intra-abdominal injury or pelvic fracture may be seen at the same time. We present a case of intraperitoneal urinary bladder rupture with pelvic fracture managed with laparoscopic repair.

Case Report: A 27-year-old drunk woman presented to emergency room with complaint of abdominal pain and dysuria after traffic accident. X-ray showed pelvic fracture and right pneumothorax. Peritoneal sign and abdominal distension were found on physical examination. Gross hematuria was found after urinary catheterization. Abdominal contrast-enhanced CT scan revealed lots of blood clot in the suprapubic area, collapsed urinary bladder, and intraperitoneal extravasation of contrast medium. Cystoscopy showed a 4-cm laceration wound in the posterior wall near the bladder trigone. Laparoscopic bladder repair with standard two-layer suture was done. Besides ascending colon contusion with hematoma was also found in the laparoscopy and conservative treatment was done. The patient experienced an uneven post-operative recovery. The urinary catheter was removed 2 weeks after operation and her urination was smooth.

Conclusions: Laparoscopic urinary bladder repair is a feasible alternative treatment to laparotomy in selected patients with stable hemodynamic status. Diagnostic laparoscopy can be also done to diagnose intraabdominal organ injuries. For young patients, patients may benefit from a laparoscopic procedure with less wound, better cosmetics, and faster recovery to work.