title: Bladder injuries in emergency/expedited laparoscopic surgery in the absence of previous surgery: a case series.
abstract: BACKGROUND
  The use of laparoscopy as a diagnostic and therapeutic tool is being used increasingly in the emergency setting with many of these procedures being performed by trainees. While the incidence of iatrogenic injuries is reported to be low, we present six emergency or expedited  cases in which the bladder was perforated by the suprapubic trocar.
  
  
  METHODS
  Three cases were related to the management of appendicitis, two to negative diagnostic laparoscopies for lower abdominal pain and one to an ectopic pregnancy. Management of the bladder injuries varied from a urinary  catheter alone to laparotomy with debridement of the abdominal wall due to sepsis and later reconstruction. Four of the six cases were performed by registrars.
  
  
  CONCLUSIONS
  Although the incidence of bladder injury is low, its importance is highlighted by the large number of laparoscopies  being performed. In addition to catheterisation of the patient, care must be taken with the insertion of low suprapubic ports and consideration should be made regarding alternative sites. Adequate laparoscopic supervision and training in port site planning is required for surgical trainees.
authors.affiliation: Royal Surrey County Hospital NHS Foundation Trust, UK. brucelevy22@hotmail.com
authors.forename: B F
authors.initials: BF
authors.lastname: Levy
authors.forename: J
authors.initials: J
authors.lastname: De Guara
authors.forename: P D
authors.initials: PD
authors.lastname: Willson
authors.forename: Y
authors.initials: Y
authors.lastname: Soon
authors.forename: A
authors.initials: A
authors.lastname: Kent
authors.forename: T A
authors.initials: TA
authors.lastname: Rockall
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000601:surgery; D000328:Adult; D001064:Appendicitis / Q000601:surgery; D004630:Emergencies; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000601:surgery; D013525:Surgical Instruments / Q000009:adverse effects; D001743:Urinary Bladder / Q000293:injuries*