title: Laparoscopic repair of intra-abdominal bladder perforation in preschool children.
abstract: Intraperitoneal bladder rupture is uncommon in very young children, but its incidence may increase with increasing use of seat and lap belts. To the best of our knowledge, there are no prior reports of laparoscopic repair of this injury in children. We describe two recent cases and discuss useful technical points that facilitate a successful laparoscopic repair. Both our patients were preschool age girls who sustained seat and lap belt injuries. Contrast computed tomography scan suggested a large amount of free peritoneal fluid and cystogram confirmed intraperitoneal bladder perforation (isolated injury). The injury was repaired using delayed absorbable sutures and intracorporeal suturing (continuous in 1, interrupted in 1) using a 3 port laparoscopic technique. Meticulous peritoneal lavage was carried out to minimise urinary peritonitis and the bladder as well as the peritoneal cavity were drained. Check cystograms (day 7) revealed no leaks. Young girls appear to be at risk of intraperitoneal bladder injuries following lap belt injuries. After exclusion of life-threatening injuries and concurrent abdominal injuries which need rapid control or preclude pneumoperitoneum, a laparoscopic repair can be safely performed.
authors.affiliation: Department of Paediatric Surgery, John Hunter Children's Hospital, Newcastle, Australia.
authors.forename: Aniruddh V
authors.initials: AV
authors.lastname: Deshpande
authors.affiliation: Department of Surgery, Westmead Hospital, Sydney, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Michail
authors.affiliation: Department of Paediatric Surgery, Princess Margaret Hospital for Children, Perth, Australia.
authors.forename: Parshotam
authors.initials: P
authors.lastname: Gera