How do you manage bladder injury during C section?
Usually the dome of the bladder is injured and the trigonal area remains away from the injury field by 6–10 cm. Bladder rent is repaired in two layers either by continuous simple or interrupted suture with 3-0 & 2-0 polyglycolic acid suture. Suprapubic cystostomy and transurethral catheter are kept for 10–14 days.
Is the bladder intraperitoneal or extraperitoneal?
Definition. The bladder is an extraperitoneal muscular urine reservoir located anatomically in the pelvic space behind the pubic symphysis. The proximity to bony structures of the pelvis predisposes this organ to injury. Most injuries are seen at the dome of the bladder, which is its weakest part.
What is intraperitoneal bladder rupture?
Intraperitoneal bladder rupture generally occurs as the result of a direct blow to a distended urinary bladder. Deceleration injuries can also cause such phenomena. This type of injury is most common in alcoholics and victims of seatbelt or steering wheel trauma.
Is the bladder intraperitoneal or retroperitoneal?
Classification of abdominal structures
| Intraperitoneal | Retroperitoneal ( or Extraperitoneal ) | Infraperitoneal / Subperitoneal |
|---|---|---|
| Kidneys, adrenal glands, proximal ureters, renal vessels | Urinary bladder, distal ureters | |
| In women: ovaries | Gonadal blood vessels, Uterus, Fallopian Tubes | |
| Inferior vena cava, aorta |
How do you suture a bladder injury?
Repair the cystotomy in two layers, using absorbable suture. Never use non-absorbable suture because it might act as a nidus for bladder calculi to form. Close the first layer with simple running 3-0 absorbable suture. Close the second layer using running imbricating 2-0 or 3-0 absorbable suture.
How do you suture your bladder?
Two monofilament nylon sutures are inserted through the abdominal wall, tangentially to the dome of the bladder, together making a purse-string suture around the cystostomy. The sutures are left untied until the top catheter is removed. Then they are tied and subsequently removed along with the skin stitches.
How do you fix a ruptured bladder?
If the tear is at the bottom or side of the bladder, the urine will leak into the tissues around the bladder instead of the abdominal cavity. Complex injuries of this type should be repaired with surgery. But often it can be treated by simply placing a wide catheter into the bladder to keep it empty.
What approximate percentage of bladder ruptures are intraperitoneal?
Bladder injuries occur in about 1.6% of patients with blunt abdominal trauma. Approximately 60% of bladder injuries are extraperitoneal, 30% are intraperitoneal, and the remaining 10% are both extra and intraperitoneal.
Which suture is most appropriate to repair bladder laceration?
Polyglactin 910 is the preferred suture to use for repair in one or two layers, depending on defect size. There are also standard guidelines for recognition and management of bladder injury during sling placement.