Mehran Ahmed | Chittagong Medical College,Bangladesh (original) (raw)
Papers by Mehran Ahmed
We report a case of bladder perforation during laparoscopic gynaecological surgery that was detec... more We report a case of bladder perforation during laparoscopic gynaecological surgery that was detected intraoperatively by gaseous distention of the urinary bag. The anaesthetist can help detect intraoperative laparoscopic bladder injury by checking the bladder catheter collection bag for gaseous distension. In this clinical report, gaseous distention of the urinary bag was the only indication of intraoperative laparoscopic bladder injury and resulted in immediate intervention and surgical repair. Intraoperative bladder injury repair will result in decreased surgical morbidity, and if performed laparoscopically may result in decreased hospital stay. Nous rapportons une perforation v~sicale survenue pendant une laparoscopie gyn~cologique et d~celOe par la distension gazeuse du sac de collecte urinaire. L'anesth~siste peut aider ~ d~celer la I~sion de la vessie en v~rifiant si le sac de collecte urinaire est distendu par du gaz. Dans l'observation actuelle, la dis-tension a ~td le seul indice d'une ldsion v~sicale perop&atoire qui a ~t~ r~par~e imm~diatement. La r~paration d'une l~sion v~sicale pendant I'intervention r~duit la morbiditd et sa r~a-lisation par laparoscopie diminue la durde du skjour hospitalier. Laparoscopy has developed from a solely diagnostic procedure to that of a therapeutic operation. However, it has its own associated complications, l and we describe a case of bladder perforation during laparoscopic-assisted vaginal hysterectomy. This Complication was detected in-traoperatively by gaseous distention of the urinary bag.' Early detection resulted in immediate intervention and repair. Case report An otherwise healthy 45-yr-old woman with uterine leio-myoma and suffering from uterine bleeding presented for laparoscopic-assisted vaginal hysterectomy. Past surgery included removal of uterine fibroids. Physical examination was unremarkable; she weighed 80 kg and was 168 cm tall. Laboratory variables were within normal limits. The monitored (SpO2, NIBP) patient was premeditated in the holding room with midazolam 2 mg/v and a lumbar epidural catheter was placed for postoperative analgesia. Anaesthesia was induced with thiopentone and fentanyl, and the tracheal intubation facilitated with ve-euronium. Preservative-free morphine (3.5 mg) was added to the lumbar epidural catheter. Anaesthesia was maintained with 65% nitrous oxide in oxygen, and isoflurance 1.5-2%. Controlled ventilation maintained end-tidal CO 2 at 33 mmHg throughout surgery. Monitoring consisted of NIBP, ECG, SpO2, ETCO2, ETAA, and temperature. Laparoscopy was begun with insertion of a 10-mm trocar infraumbilically, two 12-mm trocars lateral to the umbilicus, and a 5-ram trocar inserted under direct la-paroscopic visualization. Surgery and anaesthesia proceeded uneventfully. Urine output was 50 ml during the first hour, but after two hours there was balloon-like dis-tention of the bladder catheter bag with gas. The bag contained no urine or blood and the bladder was then filled with methylene blue. Examination through the lap-aroscope revealed intraperitoneal extravasation of the dye which confirmed the diagnosis of bladder perforation. The laparoscopic procedure was abandoned. At laparot-omy, two 5 mm cystotomies were noted through the dome of the bladder which appeared to be caused by the 5-mm trocar. They were repaired and a TAH BSO was completed uneventfully. The patient recovered from anaesthesia without incident. A bladder catheter remained in place postoperatively for seven days. The patient spiked a temperature on post-operative day #1 and was given broad spectrum antibiotics with defervescence. The remained of her hospital stay was uneventful. Discussion Operative laparoscopy has been practiced for over 40 yr and is now one of the most frequent operations to be CAN J ANAESTH 1995 / 42:5 / pp415-6
A study on 6492 new cancer patients was done at
We report a case of bladder perforation during laparoscopic gynaecological surgery that was detec... more We report a case of bladder perforation during laparoscopic gynaecological surgery that was detected intraoperatively by gaseous distention of the urinary bag. The anaesthetist can help detect intraoperative laparoscopic bladder injury by checking the bladder catheter collection bag for gaseous distension. In this clinical report, gaseous distention of the urinary bag was the only indication of intraoperative laparoscopic bladder injury and resulted in immediate intervention and surgical repair. Intraoperative bladder injury repair will result in decreased surgical morbidity, and if performed laparoscopically may result in decreased hospital stay. Nous rapportons une perforation v~sicale survenue pendant une laparoscopie gyn~cologique et d~celOe par la distension gazeuse du sac de collecte urinaire. L'anesth~siste peut aider ~ d~celer la I~sion de la vessie en v~rifiant si le sac de collecte urinaire est distendu par du gaz. Dans l'observation actuelle, la dis-tension a ~td le seul indice d'une ldsion v~sicale perop&atoire qui a ~t~ r~par~e imm~diatement. La r~paration d'une l~sion v~sicale pendant I'intervention r~duit la morbiditd et sa r~a-lisation par laparoscopie diminue la durde du skjour hospitalier. Laparoscopy has developed from a solely diagnostic procedure to that of a therapeutic operation. However, it has its own associated complications, l and we describe a case of bladder perforation during laparoscopic-assisted vaginal hysterectomy. This Complication was detected in-traoperatively by gaseous distention of the urinary bag.' Early detection resulted in immediate intervention and repair. Case report An otherwise healthy 45-yr-old woman with uterine leio-myoma and suffering from uterine bleeding presented for laparoscopic-assisted vaginal hysterectomy. Past surgery included removal of uterine fibroids. Physical examination was unremarkable; she weighed 80 kg and was 168 cm tall. Laboratory variables were within normal limits. The monitored (SpO2, NIBP) patient was premeditated in the holding room with midazolam 2 mg/v and a lumbar epidural catheter was placed for postoperative analgesia. Anaesthesia was induced with thiopentone and fentanyl, and the tracheal intubation facilitated with ve-euronium. Preservative-free morphine (3.5 mg) was added to the lumbar epidural catheter. Anaesthesia was maintained with 65% nitrous oxide in oxygen, and isoflurance 1.5-2%. Controlled ventilation maintained end-tidal CO 2 at 33 mmHg throughout surgery. Monitoring consisted of NIBP, ECG, SpO2, ETCO2, ETAA, and temperature. Laparoscopy was begun with insertion of a 10-mm trocar infraumbilically, two 12-mm trocars lateral to the umbilicus, and a 5-ram trocar inserted under direct la-paroscopic visualization. Surgery and anaesthesia proceeded uneventfully. Urine output was 50 ml during the first hour, but after two hours there was balloon-like dis-tention of the bladder catheter bag with gas. The bag contained no urine or blood and the bladder was then filled with methylene blue. Examination through the lap-aroscope revealed intraperitoneal extravasation of the dye which confirmed the diagnosis of bladder perforation. The laparoscopic procedure was abandoned. At laparot-omy, two 5 mm cystotomies were noted through the dome of the bladder which appeared to be caused by the 5-mm trocar. They were repaired and a TAH BSO was completed uneventfully. The patient recovered from anaesthesia without incident. A bladder catheter remained in place postoperatively for seven days. The patient spiked a temperature on post-operative day #1 and was given broad spectrum antibiotics with defervescence. The remained of her hospital stay was uneventful. Discussion Operative laparoscopy has been practiced for over 40 yr and is now one of the most frequent operations to be CAN J ANAESTH 1995 / 42:5 / pp415-6
A study on 6492 new cancer patients was done at