title: An unusual cause of abdominal distension: intraperitoneal bladder perforation secondary to intermittent self-catheterisation.
abstract: We report a strikingly unusual case of traumatic intraperitoneal perforation of an augmented bladder from clean intermittent self-catheterisation (CISC), which presented a unique diagnostic challenge. This case describes a 48-year-old T1 level paraplegic, who had undergone clamshell ileocystoplasty for detrusor overactivity, presenting with abdominal distension, vomiting and diarrhoea. Initial investigations were suggestive of disseminated peritoneal malignancy with ascitic fluid collections, but the ascitic fluid was found to be intraperitoneal urine from a perforation of the urinary bladder. This was associated with an inflammatory response in the surrounding structures causing an appearance of colonic thickening and omental disease. Although the diagnostic process was complex due to this patient's medical history, the treatment plan initiated was non-operative, with insertion of an indwelling urinary catheter and radiologically guided drainage of pelvic and abdominal collections. Overdistension perforations of augmented urinary bladders have been reported, but few have described perforation from CISC.
authors.affiliation: Department of Urology, Craigavon Area Hospital, Craigavon, Northern Ireland, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Martin
authors.affiliation: Department of General Surgery, Craigavon Area Hospital, Craigavon, Northern Ireland, UK.
authors.forename: Liam
authors.initials: L
authors.lastname: Convie
authors.affiliation: Department of General Surgery, Antrim Area Hospital, Antrim, Northern Ireland, UK.
authors.forename: David
authors.initials: D
authors.lastname: Mark
authors.affiliation: Department of Radiology, Craigavon Area Hospital, Craigavon, Northern Ireland, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: McClure
mesh_terms: D002408:Catheters, Indwelling; D004322:Drainage / Q000379:methods; D005260:Female; D005414:Flatulence; D006801:Humans; D008875:Middle Aged; D010264:Paraplegia / Q000150:complications; D010529:Peritoneal Cavity / Q000293:injuries*; D015641:Radiography, Interventional / Q000379:methods; D035583:Rare Diseases; D012421:Rupture; D012648:Self Care / Q000009:adverse effects*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000293:injuries*; D014546:Urinary Catheterization / Q000009:adverse effects*; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects