Bladder injuries following inguinal canal surgery in infants.
OBJECTIVE
Surgery of the inguinal canal is very common in infancy. Occasionally, injury of the bladder may occur with severe consequences. The aim of this paper was to warn young surgeons of this serious complication.


METHODS
During the last 2 years, we observed four cases of bladder injury following surgery on inguinal canal. All were males. The indication for surgery was inguinal hernia in three patients and cryptorchidism in one patient.


RESULTS
Two cases presented with urinary peritonitis. One child was referred later for a retracted bladder with reflux. In one child, the lesion was promptly recognized and repaired. Of the four cases, two ruptures of the bladder caused transient sequaele, i.e. persisting catheter drainage, and voiding disorders later. In two cases, there were serious consequences: the bladder had to be partially removed in one child, ending up in temporary ureterostomy and subsequent reconstruction with bladder augmentation. The fourth child developed a small, water clock-shaped bladder with a thick wedge of scarred tissue, and bilateral ureteral reimplantation with bladder augmentation was necessary.


CONCLUSIONS
Surgery of the inguinal canal is very common in children and infants, and is often performed by trainees. Awareness of this serious event should be emphasized in training programs.
Aloi
Ivan P
IP
Division of Pediatric Urology, Department of Nephrology and Urology, Bambino Gesù Children's Hospital and Research Institute, Piazza S. Onofrio, 4, 00165, Rome, Italy. ivanaloi@tin.it
Lais
Alberto
A
Caione
Paolo
P
D003456:Cryptorchidism / Q000601:surgery*; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D007223:Infant; D007264:Inguinal Canal / Q000601:surgery*; D007558:Italy; D008297:Male; D010538:Peritonitis / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D014511:Uremia / Q000209:etiology; D001743:Urinary Bladder / Q000293:injuries*
Surg Gynecol Obstet. 1967 Jun;124(6):1314-6
6024210
Eur J Surg. 1998 Nov;164(11):873-4
9845135
Urology. 2005 Aug;66(2):432
16051316
Pediatr Surg Int. 2004 Jan;20(1):61-4
14758496
J Urol. 2009 Jul;182(1):280-4; discussion 284-5
19450839
Radiology. 1961 Dec;77:979-83
13860571
J Urol. 1985 Jan;133(1):97-8
3964887
Urology. 1974 Jan;3(1):89-90
4591415
Indian Pediatr. 2006 Feb;43(2):179-80
16528118
Int Braz J Urol. 2007 Jul-Aug;33(4):532-5; discussion 535
17767759
Pediatr Surg Int. 1999;15(8):584-5
10631742
Surg Endosc. 2009 Jul;23(7):1428-32
19263124
Pediatr Surg Int. 1998 Mar;13(2-3):160-1
9563033