ABSTRACT
The bladder is relatively resistant to injury when collapsed and it usually moves away from the finger or scissors as it is not a fixed pelvic structure. When the bladder becomes fixed due to inflammation, cancer or previous surgery, the likelihood of bladder injury increases. Very thin bladder, loss of normal tissue planes and injudicious surgical dissection increase the risk of injury
ACTION PLAN
1Suspect in the presence of the predisposing factors and the appearance of wetness in the wound
2Confirm by the instillation of methylene blue dye and filling the bladder 3 Define the extent of injury and the margins of lacerations by cystoscopy
and the ureters catheterized to be sure that they have not been compromised by the injury and to protect them during repair
4 Immediate repair when discovered during gynaecological surgery 5 Refer to a surgeon with appropriate skills is recommended if the bladder
tear is difficult, infected, devascularized or if the ureter is suspected to be involved
6Closure of the bladder should be performed with 2-0 chromic or polygolic acid suture on a half-circle tapered needle. A simple running or running lock stitch placed in two layers will produce a secure closure
7 Following closure, the bladder should be filled to capacity to check for leaks
8A figure-of-eight suture placed over the initial repair may be necessary to eliminate leaks
9 Cystoscopy may confirm bladder repair and the absence of ureteric involvement
10Drain the bladder by a Foley’s catheter for 7-10 days 11Antibiotics for 7-10 days
