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

The cookie setting on this website is set to ‘allow cookies’ to give you the very best experience.

If you continue without changing this setting, you consent to this - but if you want, you can change your setting at any time using the ‘change cookie setting’ link at the bottom of this page.

Cookie Setting

Our Cookies

Cookie NamePurpose
eu_ask This is used to store the cookie setting you set in the form above.
If you choose 'Do Not Allow Cookies' we will need to store this information as a cookie with the value N.
If you choose 'Allow Cookies' or do not make a choice, we will store this information as a cookie with the value Y.

The value is kept for one year.

3rd Party Cookies

Cookie NamePurpose
Google Analytics This website uses Google Analytics, a web analytics service provided by Google, Inc.
Google Analytics sets a cookie in order to evaluate your use of the website and compile reports for us on activity on the website.
Google stores the information collected by the cookie on servers in the United States.
Google may also transfer this information to third parties where required to do so by law,
or where such third parties process the information on Google's behalf.
Google will not associate your IP address with any other data held by Google
By using this website, you consent to the processing of data about you by Google in the manner and for the purposes set out above.

How to reject or delete this cookie