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Cureus Apr 2024Uterine perforations caused by intrauterine contraceptive devices (IUCDs) have been rarely documented in medical literature. However, the migration of these devices into...
Uterine perforations caused by intrauterine contraceptive devices (IUCDs) have been rarely documented in medical literature. However, the migration of these devices into the bladder (intravesical migration), resulting in calculus formation, is an exceptionally uncommon occurrence. When intravesical migration happens, the IUCD may be found lodged in the bladder. In this particular case, the presence of the IUCD was detected within the bladder in the form of calculus, notably without adhering or embedding in the bladder walls. Despite being inserted nine years prior, the patient underwent seven normal deliveries without complications and remained asymptomatic concerning urinary issues until the last two years before presentation. The calculus was successfully removed from the urinary bladder via a laparotomy performed by gynecologists. This case underscores the essential role of radiological investigations and regular follow-ups in patients who report conception after IUCD insertion, as they aid in confirming the potential migration of the device and facilitate timely intervention for removal.
PubMed: 38707065
DOI: 10.7759/cureus.57582 -
Journal of the Anus, Rectum and Colon 2024Deep pelvic abscesses are surrounded by the pelvic bones, bladder, gynecological organs, intestinal tract, and nerve and vascular systems, and are approached by various...
OBJECTIVES
Deep pelvic abscesses are surrounded by the pelvic bones, bladder, gynecological organs, intestinal tract, and nerve and vascular systems, and are approached by various routes for drainage. The transgluteal approach is often performed under computed tomography guidance; however, if ultrasonography can be used to confirm the approach, it is considered more effective because it reduces radiation exposure and allows for real-time puncture under sonographic and fluoroscopic guidance.
METHODS
This retrospective study was conducted at Tobata Kyoritsu Hospital (Fukuoka, Japan) between April 1, 2021, and December 31, 2022. Sonographically guided transgluteal drainage with fluoroscopy was performed in five consecutive cases of deep pelvic abscesses using a 3D image analysis system (SYNAPSE VINCENT) to study the anatomy for safe puncture.
RESULTS
Three patients had postoperative abscesses from colorectal cancer, one caused by perforation of the appendicitis, and one caused by sigmoid diverticulitis. The average drainage duration was 11 days (SD = 6.7). No complications, such as bleeding or nerve damage, were observed.
CONCLUSIONS
We constructed a 3D image of the puncture route of the trans greater sciatic foramen using SYNAPSE VINCENT to objectively comprehend the anatomy and puncture route. The ideal transgluteal approach is to insert the catheter as close to the sacrum as possible at the level of the infrapiriformis. The parasacrum infrapiriformis approach can be performed safely and easily using ultrasound guidance and fluoroscopy.
PubMed: 38689787
DOI: 10.23922/jarc.2023-054 -
International Journal of Surgery Case... Apr 2024Gallbladder volvulus is the rarest form of gall bladder pathology and it is also rare cause of acute abdomen. The exact etiology of gallbladder volvulus is undetermined...
INTRODUCTION
Gallbladder volvulus is the rarest form of gall bladder pathology and it is also rare cause of acute abdomen. The exact etiology of gallbladder volvulus is undetermined and mostly mimics acute cholecystitis which delays diagnosis and management of patients.
CASE PRESENTATION
In this case report we present 7 years old male child who underwent exploratory laparotomy and intraoperative findings of 360 degree twisted, frankly gangrenous, and perforated at the fundus of the gallbladder. Cholecystectomy was done and the patient had smooth post-operative course and discharged improved.
CLINICAL DISCUSSION
Gallbladder volvulus is a rare cause of acute abdomen especially in pediatric population and it mostly mimics acute acalculous cholecystitis leading to delayed diagnosis and increased risk of complications such as gallbladder gangrene, perforation, bile peritonitis, morbidity and mortality.
CONCLUSION
Even though gallbladder volvulus is rare as cause of acute abdomen, one has to consider in the differential diagnosis as high index of suspicion is important for early diagnosis and management.
PubMed: 38688150
DOI: 10.1016/j.ijscr.2024.109664 -
Cureus Mar 2024Hysterectomy, one of the most common surgical procedures performed in women worldwide, assumes a very important role in the definitive management of diverse gynecologic...
Hysterectomy, one of the most common surgical procedures performed in women worldwide, assumes a very important role in the definitive management of diverse gynecologic conditions. This case report presents a compelling instance of an iatrogenic bladder perforation that occurred during laparoscopically assisted vaginal hysterectomy in a 47-year-old woman with a high body mass index, extensive surgical history, and postural orthostatic tachycardia syndrome. Despite considerable preoperative planning and the use of minimally invasive techniques, the occurrence of physician-induced bladder perforation highlights the significance of understanding anatomical relationships and variations. The patient's previous abdominal surgeries including two cesarean sections, appendectomy, and cholecystectomy likely contributed to scar formation and adhesions, making dissection challenging. The case report and following discussion delve into anatomical variations, as well as the diagnosis and management of iatrogenic bladder injuries. The presented case serves as a valuable addition to the literature, contributing insights into the challenges and considerations surrounding urinary tract injuries during hysterectomy. This paper aims to review current research and guide practicing obstetricians and gynecologists in the management of intraoperative bladder injuries.
PubMed: 38646348
DOI: 10.7759/cureus.56556 -
International Journal of Surgery Case... May 2024Bladder stones, although rare in a healthy bladder, can emerge due to various factors, including obstructions in urinary flow, recurrent infections, and foreign bodies....
INTRODUCTION AND IMPORTANCE
Bladder stones, although rare in a healthy bladder, can emerge due to various factors, including obstructions in urinary flow, recurrent infections, and foreign bodies. Intrauterine contraceptive devices (IUCDs) are known for their potential to migrate from the uterine cavity, leading to unusual complications such as bladder stone formation.
CASE PRESENTATION
A 52-year-old woman, previously treated for a complicated urinary tract infection, presented with intermittent lower abdominal pain, dysuria, and hematuria. She had a history of an IUCD insertion 15 years earlier, which was later documented as missing. Diagnostic imaging revealed a large bladder stone, encasing the previously inserted IUCD. An open vesicolithotomy was performed, during which a stone measuring 6 × 5 cm was removed, revealing the IUCD within. The patient had an uncomplicated recovery with no further urinary tract infections at a 6-month follow-up.
CLINICAL DISCUSSION
The migration of an IUCD can lead to various complications, depending on its final location. The formation of bladder stones around a migrated IUCD is a rare but significant complication, necessitating a thorough diagnostic approach. Radiography and ultrasonography proved sufficient for diagnosing the intravesical migration in this case.
CONCLUSION
This case underscores the importance of considering a migrated IUCD in the differential diagnosis of patients presenting with urinary symptoms, especially those with a history of a missing IUCD. Timely diagnosis and management are crucial in preventing further complications.
PubMed: 38615469
DOI: 10.1016/j.ijscr.2024.109622 -
European Journal of Case Reports in... 2024Rectus sheath haematoma (RSH) has become increasingly common but is often underdiagnosed. Prompt diagnosis will avoid unnecessary investigations and procedures,...
INTRODUCTION
Rectus sheath haematoma (RSH) has become increasingly common but is often underdiagnosed. Prompt diagnosis will avoid unnecessary investigations and procedures, resulting in early treatment and a better outcome.
CASE DESCRIPTION
We described a case of a spontaneous RSH with intraperitoneal extension and formation of a vesico-haematoma fistula, which was initially misdiagnosed as a urinary tract infection. The diagnosis was made ten days after admission, when a CT scan showed an over-16 cm RSH with intraperitoneal extension, bladder perforation and a vesico-haematoma fistula. The patient was managed conservatively.
DISCUSSION
RSH accounts for less than 2% of acute abdomen cases and is often unrecognised. Its presentation can mimic other intra-abdominal pathologies, and the diagnosis is often delayed or missed. Complications can arise from an RSH although it is generally viewed as a self-limiting condition.
CONCLUSION
RSH has become increasingly common, and we would like to highlight the need to include abdominal wall pathologies in the initial differential diagnoses of acute abdomen to avoid delay in diagnosis.
LEARNING POINTS
Rectus sheath haematoma has become increasingly common due to the use of anticoagulants.The presentation can be non-specific and mimic other intra-abdominal pathologies. Misdiagnosis or delayed diagnosis can result in complications and unnecessary invasive procedures.Abdominal wall pathologies including rectus sheath haematomas should be included in initial differentials of acute abdomen.
PubMed: 38584897
DOI: 10.12890/2024_004362 -
BMJ Case Reports Apr 2024Vaginal pessaries are widely considered to be a safe and effective non-surgical management option for women with pelvic organ prolapse. Complications may occur, and are...
Vaginal pessaries are widely considered to be a safe and effective non-surgical management option for women with pelvic organ prolapse. Complications may occur, and are more frequent with improper care and certain device designs and materials. It is imperative to provide information to patients about potential complications. We present the case of a woman in her 70s who presented to the Emergency Department with increasing groin and abdominal pain following a vaginal pessary insertion 2 days prior for grade 3 vaginal vault prolapse. On presentation, her abdomen was markedly distended with guarding. Laboratory investigations showed a significant acute kidney injury with a metabolic acidosis. An initial non-contrast CT showed fluid and inflammatory changes surrounding the bladder, and bladder perforation was suspected. A subsequent CT cystogram showed extravasation of contrast from the bladder into the peritoneal cavity, in keeping with an intraperitoneal bladder rupture. The patient underwent an emergency bladder repair in theatre.
Topics: Humans; Female; Pessaries; Urinary Bladder; Pelvic Organ Prolapse; Urinary Bladder Diseases; Vagina; Abdominal Injuries
PubMed: 38569734
DOI: 10.1136/bcr-2023-257233 -
Pediatric Reports Mar 2024To compare suprapubic access (SPA) and transurethral catheterization (TUC) in voiding cystourethrogram (VCUG).
PURPOSE
To compare suprapubic access (SPA) and transurethral catheterization (TUC) in voiding cystourethrogram (VCUG).
METHODS
Retrospective single-center evaluation of 311 VCUG performed in male patients under 12 years of age. Two study groups were built based on the bladder access method. TUC was performed in 213 patients, whereas 98 received SPA. The groups were compared regarding the procedural switch rate, the complication rate, radiation parameters, the amount of contrast media applied and the examination quality. Complications were graded in minor (contrast leakage, premature termination of the examination) and major (fever, urinary tract infection, bladder perforation). Fluoroscopy time and radiation parameters were compared. Examination quality was assessed based on the satisfactory acquisition of fluoroscopic images using a four-point Likert scale.
RESULTS
In 9% of the SPA examinations a method switch to TUC was necessary. The minor complication rate was 1.9% for TUC and 35.7% for SPA ( < 0.001). The major complication rate was 0.9% for TUC and 2% for SPA ( > 0.05). Mean fluoroscopy time and radiation dose were significantly lower in TUC (TUC, 26 ± 19 s, 0.6 ± 1.2 µGy·m; SPA, 38 ± 33 s, 1.7 ± 2.9 µGy·m; = 0.01/0.001). There was no significant difference regarding the amount of contrast media applied (TUC, 62 ± 40 mL; SPA, 66 ± 41 mL; > 0.05) and the examination quality with full diagnostic quality achieved in 88% of TUC and 89% of SPA examinations ( > 0.05).
CONCLUSIONS
As TUC provides significantly lower radiation exposure and less periprocedural complications, it should be the primary bladder access route for VCUG in pediatric male patients.
PubMed: 38535513
DOI: 10.3390/pediatric16010017 -
World Journal of Gastroenterology Feb 2024Colonoscopy is an integral part of the lower bowel care and is generally considered a potentially safe diagnostic and therapeutic procedure performed as a daycare...
Colonoscopy is an integral part of the lower bowel care and is generally considered a potentially safe diagnostic and therapeutic procedure performed as a daycare outpatient procedure. Colonoscopy is associated with different complications that are not limited to adverse events related to the bowel preparation solutions used, the sedatives used, but to the procedure related as well including bleeding and perforation. Injuries to the extra-luminal abdominal organs during colonoscopy are uncommon, however, serious complications related to the procedure have been reported infrequently in the literature. Life threatening injuries to the spleen, liver, pancreas, mesentery, and urinary bladder have been reported as early as in mid-1970s. These injuries should not be overlooked by clinicians and endoscopists. Steadily increasing abdominal pain, abdominal distension, and hemodynamic instability in absence of rectal bleeding should raise the possibility of severe organ injury. Splenic and hepatic injury following colonoscopy are usually serious and may be life threatening. Although conservative management may help, yet they usually need interventional radiology or surgical intervention. Acute pancreatitis following colonoscopy is usually mild and is mostly managed conservatively. The mechanism of abdominal organ injuries during colonoscopy is not fully understood, however many risk factors have been identified, which can be classified as- organ related, procedure related, and local abdominal factors. Difficult colonoscopy and prior intra-abdominal adhesions are probably the most relevant risk factors for these injuries. Left lateral position, avoidance of looping and excessive force during the procedure would probably reduce the risk of such injuries.
Topics: Humans; Acute Disease; Pancreatitis; Spleen; Abdominal Injuries; Gastrointestinal Hemorrhage; Colonoscopy
PubMed: 38515946
DOI: 10.3748/wjg.v30.i7.624 -
Urology Case Reports Mar 2024Iatrogenic bladder trauma (IBT), a rare complication of Caesarean delivery (CD), can present with delayed symptoms, posing diagnostic challenges. A case study reports...
Iatrogenic bladder trauma (IBT), a rare complication of Caesarean delivery (CD), can present with delayed symptoms, posing diagnostic challenges. A case study reports IBT presenting six days post-CD, initially undetected by retrograde cystography and CT urography. Subsequent surgical exploration revealed an 8-cm wound in the bladder dome, concealed by a hematoma and enlarged uterus. While retrograde cystography is typically accurate, false negatives may occur. CT cystography offers higher sensitivity but may still miss small perforations. Delayed IBT can manifest with abdominal pain, hematuria, and elevated renal function tests, warranting clinical suspicion and consideration of surgical exploration despite negative imaging.
PubMed: 38495850
DOI: 10.1016/j.eucr.2024.102679