We report the case of a 23-year-old male involved in a motor vehicle collision as a restrained passenger. He had been drinking alcohol prior to the collision. Upon presentation to the trauma service, he was complaining of right hip pain; otherwise he was hemodynamically stable. He did not have any markings on his abdomen nor pelvis region such as a "seatbelt sign." After an initial evaluation, he was taken to radiology where a CT scan of his abdomen and pelvis was performed. There was a moderate amount of fluid in his pelvis, which on closer inspection appeared to be a disruption in his bladder wall. A retrograde cystogram confirmed our suspicion of an intraperitoneal bladder injury, and the patient was taken to the operating room (Figure 1).
Because this patient remained hemodynamically stable and the only other injury was a pubic rami fracture, we decided to perform a laparoscopic repair of this injury. First, a cystoscopy was performed to ensure the injury was at the dome of the bladder, and not involving the ureters or the trigone. Second, bilateral 5-French ureteral catheters were inserted as well as a 24-French Foley catheter. Next, we performed laparoscopic repair of the intraperitoneal bladder injury. We used a 12-mm infraumbilical port and two 5-mm ports laterally. Upon entering the abdomen, the entire abdominal contents were examined and noted to be without other injuries. There was a mild amount of bloody urine in the pelvis at the posterior cul-de-sac. A 3-cm defect was noted at the dome of the bladder (Figure 2). The Foley catheter was visualized within the bladder defect. We repaired the injury with absorbable suture in a 2-layer intracorporeal running fashion. After the repair was completed, the Foley catheter was irrigated with 100mL of sterile saline. A watertight seal had been created (Figure 3).
This patient was admitted to the hospital for 2 days. He left the hospital with his Foley catheter in place. At a follow-up visit 10 days out from surgery, a cystogram was performed, and the catheter removed when no extravasation of contrast was visualized.