Bladder injury during pediatric laparoscopic appendectomy: diagnosis and management
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LETTER TO THE EDITOR
Bladder injury during pediatric laparoscopic appendectomy: diagnosis and management Riccardo Guanà1,3 · Alessandro Pane1 · Elisa Cerchia1,2 · Salvatore Garofalo1 · Federico Scottoni1 · Daniela Marazzato1 · Simona Gerocarni Nappo1,2 · Fabrizio Gennari1 Received: 26 May 2020 / Revised: 23 June 2020 / Accepted: 28 June 2020 © Springer Nature Singapore Pte Ltd 2020
Dear Editor, Minimally invasive procedures have been routinely performed in pediatric centers in the last 2 decades, however complications are not negligible even after a proper learning curve. A 11-year old boy presented to our Emergency Department with a history of lower abdominal pain, fever and nausea for a week. A laparoscopic appendectomy was performed on the day of presentation. An 8Fr Foley catheter was inserted in the bladder prior to surgery. The first 5-mm balloon umbilical port, was placed via an open technique to accommodate a 0-degree 5-mm camera. The pneumoperitoneum was established with CO2 at 10 mmHg pressure, then the second 5-mm port was placed under vision in the left iliac fossa. The intraoperative findings demonstrated a perforated appendicitis with purulent collection and thick adhesions between the appendix and the abdominal wall at the level of the medial umbilical ligament. A third bladed 5-mm port was inserted in the suprapubic region, just slightly on the left side of the midline, in order to avoid the inflamed mass. Monopolar meticulous dissection of the appendix from the surrounding structures was performed. The appendix was excised with our standard technique (2 endoloops at the base) and removed through the umbilical port via an endobag. After an extensive washout with saline solution, an
* Riccardo Guanà [email protected] 1
Department of Pediatric General Surgery, Regina Margherita Children’s Hospital, AOU Città della Salute e della Scienza, Turin, Italy
2
Department of Pediatric Urology, Regina Margherita Children’s Hospital, AOU Città della Salute e della Scienza, Turin, Italy
3
Division of Pediatric General, Thoracic and Minimally Invasive Surgery, Regina Margherita Children’s Hospital, Piazza Polonia 94, 10126 Turin, Italy
abdominal drain was left in the site of the suprapubic collection, passing through the suprapubic port site. On postoperative day 1, the Foley catheter was removed. Shortly after catheter removal, the patient had dysuria and developed a suprapubic painful swelling. At clinical examination, the abdomen was mildly tender, especially in the lower quadrants. The discharge of clear yellow fluid was clearly seen around the abdominal drain at the suprapubic port-site. A cystogram was promptly performed, but it did not reveal any contrast leakage (Fig. 1a). Abdominal ultrasound (US) was performed in order to explore the subcutaneous hypogastric region where a small interruption of the bladder wall was observed underneath the drain (Fig. 1b). No significant fluid collection was found in the Douglas pouch. The drain was removed and an adequate transurethral catheter w
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