Create a surgical morbidity and mortality presentation for a missed intraperitoneal bladder rupture after a routine transurethral bladder tumor resection. Include the severity grading (clavien dindo / accordian system) of the case: grade 3 requiring surgical take back. M&M conference is about a 80M who underwent a transurethral resection of bladder tumor/ stones in bladder wall and presented a day after his post-op appointment with severe abdominal pain. During workup in the Emergency Department patient was worked up for a bladder perforation with a CT cystogram. The ED sent him home accidentally however did return later in the morning for further workup with his initial surgeon (Dr Hartman) who decided on conservative management given his resolution of pain and stable vitals (with foley catheter, rather than surgical repair). The next day, patient represented with return of severe abdominal pain and was quickly taken for emergency exploratory laparotomy and cystorraphy. There was persistent leak despite surgery and patient was planned for bilateral nephrostomy tubes after post-op. On post-op day #1, patient underwent successful bilateral nephrostomy tube placement. Over the next few days, JP Cr decreased from 9 to <2 and nephrostomy tube output increased suggesting appropriate proximal diversion. This M&M should contain highlights of appropriate bladder perforation workup, research on CT cystogram protocol for bladder perforation repair, and bladder repair management. Use the supporting material attached to populate details of the pre-operative history, emergency room consult and clinic plan, and postop events (inpatient notes)
Create a surgical morbidity and mortality presentation for a missed intraperitoneal bladder rupture after a routine transurethral bladder tumor resection. Include the severity grading (clavien dindo / accordian system) of the case: grade 3 requiring surgical take back. M&M conference is about a 80M who underwent a transurethral resection of bladder tumor/ stones in bladder wall and presented a day after his post-op appointment with severe abdominal pain. During workup in the Emergency Department patient was worked up for a bladder perforation with a CT cystogram. The ED sent him home accidentally however did return later in the morning for further workup with his initial surgeon (Dr Hartman) who decided on conservative management given his resolution of pain and stable vitals (with foley catheter, rather than surgical repair). The next day, patient represented with return of severe abdominal pain and was quickly taken for emergency exploratory laparotomy and cystorraphy. There was persistent leak despite surgery and patient was planned for bilateral nephrostomy tubes after post-op. On post-op day #1, patient underwent successful bilateral nephrostomy tube placement. Over the next few days, JP Cr decreased from 9 to <2 and nephrostomy tube output increased suggesting appropriate proximal diversion. This M&M should contain highlights of appropriate bladder perforation workup, research on CT cystogram protocol for bladder perforation repair, and bladder repair management. Use the supporting material attached to populate details of the pre-operative history, emergency room consult and clinic plan, and postop events (inpatient notes)
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This presentation explores a complex case of an 80-year-old male with recurrent high-risk non-muscle invasive bladder cancer (NMIBC) and a challenging surgical history. We will discuss the preoperative context, including a TURBT procedure and subsequent complications leading to severe abdominal pain. The focus will be on the initial diagnostic signals and the management decisions made, highlighting systemic failures and the rationale behind conservative management strategies. Emphasis will be...