title: Diagnosis of perforated enterocystoplasty.
abstract: In the operation of enterocystoplasty, now widely practised, segments of bowel are used to augment or replace the urinary bladder. An occasional complication is perforation, and this may present in non-specialist settings. We investigated the management of spontaneous perforations among 264 patients with enterocystoplasty followed by one surgeon for 2-18 years. Patients' charts were examined for data on presentation, diagnosis and treatment. 10 patients had thirteen perforations; data were available for nine perforations in 9 patients. Mean time from enterocystoplasty to perforation was 45 months. Presentation was shoulder pain in 1 and abdominal pain (with or without fever) in 8. Perforation was diagnosed without delay in 3, but the initial diagnosis was urinary tract infection in 4 and small-bowel obstruction in 2. Ultrasound was the most useful investigation being diagnostic in 6 of 7 cases; contrast cystography showed a leak in only 2 of the 6 patients in whom it was performed. Treatment was successful in 8 cases (surgery 6; percutaneous drainage 2); 1 patient, who remained undiagnosed, was treated medically and died. Patients with enterocystoplasty need to be educated about this potentially lethal complication, so that they can alert non-specialist clinicians to what may have happened. In any patient with enterocystoplasty who reports abdominal pain or shoulder pain, perforation has to be ruled out.
authors.affiliation: Institute of Urology and Nephrology, 48 Riding House Street, London W1P 7PN, UK.
authors.forename: Eric
authors.initials: E
authors.lastname: Fontaine
authors.forename: Rachel
authors.initials: R
authors.lastname: Leaver
authors.forename: Christopher R J
authors.initials: CR
authors.lastname: Woodhouse
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D006801:Humans; D010353:Patient Education as Topic; D020069:Shoulder Pain / Q000209:etiology; D001743:Urinary Bladder / Q000293:injuries* / Q000601:surgery; D001745:Urinary Bladder Diseases / Q000150:complications* / Q000601:surgery; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000209:etiology*