Case Study - July 2009

This is the abdominal CT scan of a 59-year-old woman who underwent endoscopic resection of multifocal, right-sided bladder tumours followed by single-dose, intra-vesical Mitomycin C. She was re-admitted 12 hours later with increasing lower abdominal pain, frequency, dysuria and poor urine output.

  1. What does the CT show?
  2. How has this condition arisen?
  3. What treatment is needed?

Reveal Answer

Open answer There is no fixed answer to this question, however your response should be similar to the one below:

  1. The CT shows extensive extravasation of urine outside the bladder on the right side. There is also contrast medium extending into the pelvis (arrowed)
  2. This has arisen due to a combination of intra-peritoneal and extra-peritoneal perforation of the bladder during the tumour resection
  3. Initial management is by urethral catheterisation. This relieved her symptoms immediately. The catheter was removed after 7 days without a recurrence of her pain.

Further comments
Extra-peritoneal extravasation following tumour resection is probably relatively common, especially in women, where the bladder wall tends to be very thin. It rarely causes symptoms. When symptomatic, simple bladder catheterisation, together with broad-spectrum antibiotics, usually resolves the situation and formal open exploration with drainage is rarely necessary.

illustrative image for answer to question $n

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