title: Laparoscopic treatment of post-cesarean section bladder flap hematoma: A feasible and safe approach.
abstract: Bladder-flap haematoma (BFH) is a puerperal complication after caesarean section; it consists of a blood collection between the bladder and the lower uterine segment, in the vesico-uterine space, and it results from bleeding at the uterine suture. Ten symptomatic women were hospitalized and underwent a laparoscopy performed by tumescence incision, bladder wall detachment from the vesico-uterine space, drainage of the fluid material inside the collection, washing of the haematoma site and peritoneal suturing. After seven days, the time it takes to develop a BFH after caesarean section, laparoscopically collected dates were, on average: Total laparoscopy time 31 min, intrasurgical blood loss 36.5 ml, two patients with a draining catheter in the pelvis, two women who developed post-operative urinary symptoms; the duration of hospital stay was 1.3 days. None of the women had complications during the post-dismissal follow-up, and no further therapeutic intervention was required. No clear, defined and standardized protocols exist for the clinical and surgical management of post-caesarean section BFH; the conservative laparoscopic approach proposed would offer women a potentially safe and feasible minimally invasive treatment, reserving hysterectomy for severe uterine necrosis, myometritis or abscess formations. These findings should be confirmed by large extensive trials.
authors.affiliation: Department of Obstetrics and Gynaecology, Vito Fazzi Hospital, Lecce, Italy. andreatinelli@gmail.com
authors.forename: Andrea
authors.initials: A
authors.lastname: Tinelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Malvasi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Vittori
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000209:etiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D010865:Pilot Projects; D011247:Pregnancy; D013997:Time Factors; D001745:Urinary Bladder Diseases / Q000209:etiology / Q000601:surgery*