Laparoscopic Management of Delayed Repair of Extra Peritoneal Bladder Rupture - Report of 2 Cases

Laparoscopic repair of traumatic intraperitoneal bladder injuries has been described since 19951,2. However delayed laparoscopic repair of extraperitoneal injury has not been reported yet to our knowledge. Majority of the extra peritoneal bladder injury occur following motor vehicle accidents, fall or crush injuries resulting in pelvic fracture. Small extra-peritoneal bladder injury heals spontaneously and hence is treated conservatively. However when the tear is more than 1 cm and there is significant extravasation of urine; immediate surgery is indicated. Occasionally bony spicule can impinge into the bladder resulting in a non healing tear. We present two cases of non healing extra-peritoneal bladder injury initially managed conservatively in a trauma center with supra-pubic catheter (SPC) or urethral foley catheter. Cystogram was done after 8 and 6 weeks showed persistent leakage of contrast. Hence patient was managed by laparoscopic repair of persistent extra-peritoneal bladder rent. To our knowledge this is the first report of a transperitoneal repair of delayed extraperitoneal bladder injury with omental interposition.

Keywords: Laparoscopic Urology, Extraperitoneal Bladder injury, Pelvic injury.