Intraperitoneal Bladder Injury – A Conservative Approach

Iatrogenic bladder injuries with Intra-peritoneal extravasations are standardly managed surgically. However, we are presenting a case of iatrogenic intra-peritoneal bladder injury which developed after an emergency caesarean section that was managed successfully by conservative therapy. The trial of conservative approach may prove beneficial to minimize the chances of any invasive interventions in such cases. Bladder injuries are of two types namely intra-peritoneal and extra-peritoneal. Of which, extra-peritoneal is most common type.1 Bladder laceration happens during separation of bladder from uterine cervix during caesarean sections and abdominal hysterectomies.2 Usually bladder injuries are identified intra-operatively and managed on table. If diagnosis is made post-operatively, then management becomes challenging due to non-specific clinical features, exposure to radiation, sepsis due to urinary extravasation and prolonged hospital stay, psychological stress to both patient and surgeon. The clinical features suspicious of bladder injury are abdomen distension, urinary ascites, blood-stained urine, abdominal pain, paralytic ileus, fever and deranged renal parameters.3 Extra-peritoneal and intra-peritoneal bladder ruptures are treated differently. According to American Urological Association (AUA) guidelines, Intraperitoneal bladder injury needs surgical repair. There are limited case reports in literature about conservative management of small intra-peritoneal bladder lacerations. This is a case report of one such intra-peritoneal bladder injury treated with non-operative approach.