Recurrent Spontaneous Bladder Perforation: A Complication of Laparoscopic Colposuspension?

Spontaneous perforation of the bladder is rare. We report a case of recurrent spontaneous bladder perforation following laparoscopic colposuspension. CASE REPORT A 65-year-old woman presented with lower abdominal pain and signs of peritonitis. Apart from a transperitoneal laparoscopic colposuspension performed 17 months earlier, medical history was unremarkable. The patient underwent exploratory laparotomy and a small hole was observed in the dome of the bladder. The hole was closed with catgut suture and the bladder was drained with a urethral catheter for 10 days. The postoperative period was uneventful. Subsequently flexible cystoscopy and residual urine volume assessment showed no abnormality. Review of the operative chart revealed that a suprapubic catheter had been inserted transperitoneally at the time of laparoscopic colposuspension. Fifteen months later the patient was rehospitalized with sudden onset of lower abdominal pain and signs of acute peritonitis. At laparotomy there was urine in the peritoneum and a hole was observed in the dome of the bladder. The hole together with the normal bladder tissue surrounding it was excised and the remaining hole was closed with chromic catgut suture. Recovery was uneventful. Histological evaluation of the bladder tissue demonstrated chronic inflammation, fibrosis and granulation tissue. There was no evidence of malignancy. DISCUSSION Most cases of bladder perforation are associated with foreign bodies or abnormalities of the bladder. 1–3 We report a case of recurrent spontaneous bladder perforation. In this case the perforation may have been related to previous suprapubic catheter insertion as the sites for both perforations were at the dome of the bladder. Suprapubic catheters are usually inserted extraperitoneally and the leakage after removal is extraperitoneal. However, the suprapubic catheter was inserted transperitoneally in this case, and probably was responsible for intraperitoneal rupture of the bladder. The bladder tissue excised at the second operation showed chronic inflammation and granulation tissue, suggesting poor wound healing. However, it was surprising that these episodes were more than a year apart without evidence of any abnormality found during the investigation.