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TROUBLESHOOTING IN MINIMAL ACCESS SURGERY
Year : 2021  |  Volume : 17  |  Issue : 4  |  Page : 584-585
 

Iatrogenic bladder perforation post laparoscopic totally extraperitoneal inguinal hernia repair: Troubleshooting with laparoscopic approach


1 Department of Surgery, Dr. L H Hiranandani Hospital, Mumbai, Maharashtra, India
2 Department of General and Laparoscopic Surgery, Dr. L H Hiranandani Hospital, Mumbai, Maharashtra, India

Date of Submission01-Feb-2021
Date of Decision21-May-2021
Date of Acceptance03-Jun-2021
Date of Web Publication16-Jul-2021

Correspondence Address:
Dr. Rafique Umer Harvitkar
Department of Surgery, Dr. L H Hiranandani Hospital, Mumbai - 400 076, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmas.JMAS_43_21

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How to cite this article:
Harvitkar RU, Joshi A. Iatrogenic bladder perforation post laparoscopic totally extraperitoneal inguinal hernia repair: Troubleshooting with laparoscopic approach. J Min Access Surg 2021;17:584-5

How to cite this URL:
Harvitkar RU, Joshi A. Iatrogenic bladder perforation post laparoscopic totally extraperitoneal inguinal hernia repair: Troubleshooting with laparoscopic approach. J Min Access Surg [serial online] 2021 [cited 2021 Dec 1];17:584-5. Available from: https://www.journalofmas.com/text.asp?2021/17/4/584/321686


A 40-year-old male presented with an uncomplicated right inguinal hernia. He gave a history of having undergone laparoscopic totally extraperitoneal hernia (TEP) repair for left inguinal hernia 2 years back. He underwent an apparently uneventful right TEP for his present condition. Postoperatively, he developed massive scrotal and penile oedema. A per urethral catheter was inserted on post-operative day 2 for retention of urine. Despite this, he continued to have severe pain in his lower abdomen. An abdominal examination revealed severe tenderness in the lower abdomen. He was referred to us with these symptoms. The patient then underwent a contrast enhanced computed tomography(CECT) scan of the abdomen and pelvis [Figure 1]. Subsequent to this, an emergency laparoscopic surgery was performed through the same three trocar sites(of the recent right TEP repair performed 5 days ago), to repair / rectify the pathology found on the CECT scan [Figure 2], [Figure 3], [Figure 4]. The probable culprit that caused the postoperative complication is also shown [Figure 5]. We present this case as one that involves laparoscopic troubleshooting of a post-operative (TEP) complication.
Figure 1: Contrast-enhanced computed tomography abdomen – (a) A coronal section shows a rent in the anterior wall of the urinary bladder(red arrow) with extravasation of urine (orange asterisk shows extravasated urine). The semi-filled urinary bladder (red asterisk) with per urethral catheter bulb in situ (yellow arrow) is also seen; (b) Sagittal section shows the contrast-filled urinary bladder (red asterisk) with extravasation of contrast through the rent in its anterior wall (red arrow). The extravasated contrast (orange asterisk) is seen anterosuperior to the bladder

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Figure 2: Intraoperative pictures during the emergency laparoscopy performed on post-operative day 5 – (a) Extravasated urine (yellow asterisk) being sucked out, (b) Infected mesh with pus flakes being cut out and removed

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Figure 3: The perforation on the anterior wall of the urinary bladder (blue arrow) along with the per urethral catheter bulb inside the bladder, seen through the perforation

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Figure 4: Suture repair – (a) Suture closure of the bladder perforation with 3-0 PDS (yellow arrow), (b) The end result (yellow arrow). A Romsons 32-Fr tube drain was left in situ and brought out from the right working trocar site. An open herniorrhaphy was performed in the same sitting. He had an uneventful post-operative recovery, and the per urethral catheter was removed on post-operative day 15

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Figure 5: The probable culprit – the contralateral (left) working trocar entry (at the time of the right laparoscopic totally extraperitoneal hernia repair, 5 days before the emergency laparoscopy), through the mesh and the adhesions around the mesh of the previous surgery (left laparoscopic totally extraperitoneal hernia repair, 2 years ago). However, there was no obvious bladder injury or extravasation of urine noted at this time (either during trocar entry or during the running length of the operation)

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04