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Iatrogenic bladder injury from port insertion during laparoscopic appendicectomy
  1. Chloe Liwen Lim,
  2. Shu Hui Neo,
  3. Lui Shiong Lee and
  4. Palaniappan Sundaram
  1. Urology, Sengkang General Hospital, Singapore
  1. Correspondence to Dr Chloe Liwen Lim; chloe.lim{at}mohh.com.sg

Abstract

A 26-year-old man underwent laparoscopic appendicectomy for acute appendicitis that was carried out uneventfully after initial urethral catheterisation to empty the bladder. Postoperatively, he developed oliguria associated with high drain output and elevated drain fluid creatinine. A contrast-enhanced computed tomography urography scan showed a small amount of contrast in the intraperitoneal space. A diagnostic laparoscopy performed for a suspected bladder injury revealed that the drain (inserted via the suprapubic port) had traversed the bladder. The drain was removed, and the bladder defects were repaired. The catheter was removed 2 weeks later uneventfully. It is important to recognise and avoid the urinary bladder during suprapubic port insertion during laparoscopic appendicectomy. This complication can be minimised via initial bladder decompression and introduction of the suprapubic port lateral to the umbilical ligaments. A high index of suspicion is required to diagnose a small bladder injury.

  • urological surgery
  • general surgery
  • urology
  • surgery

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Footnotes

  • Contributors This case report was written under the supervision of PS. The patient was cared for by PS, SHN and CLL.CLL and SHN contributed to drafting of the article and obtaining of images. CLL contributed to editing of images. CLL, LSL and PS contributed to critical revisions of the article. All authors (CLL, SHN, LSL and PS) have reviewed the final manuscript and approved for its submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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