A Case of Reverse Dialysis: Bladder Perforation During Robotic Hysterectomy Presenting as Acute Renal Failure

Abstract

Robotic surgery is gaining more fame due to its advantages over laproscopic surgery especially in gynecological procedures. Intra operative complications are far less in the former. Bladder perforation is a rare intra operative complication of robotic hysterectomy that can present as fatal electrolyte disturbances, sepsis and might even give a picture of acute renal failure. We present a case of a bladder perforation status post hysterectomy that arrived in emergency with the symptoms of nausea, vomiting and ascities. Her blood chemistry was consistent with acute renal failure but with no radiological evidence of kidney disease. Cystoscopy and ureterography revealed a bladder perforation. The clinical and lab picture was thought to be due to the same injury that might have caused the urea and creatinine to be absorbed in the peritoneal cavity. The diagnosis was supported by the fact that her symptoms and abnormal lab values reverted to normal after the repair of the injury. The case which we have presented is yet another in league to help physician making diagnosis of bladder injury when they see a patient with a rapid hypercreatininemia and ascities of short duration especially in the setting of a recent intra abdominal surgery.




doi:10.4021/wjnu6e