A 61-year-old male patient with an allergy to acetylsalicylic acid, metamizole, and cibalgina, who in July 1995 underwent surgery for radical cystectomy (bladder stage: G3 pT3abladder replacement).
Ev anodin.
Shortly after, the patient did not require self-procedures due to poor post-voidance.
In July 2001, the patient presented with pain in the right hypochondrium, associated with nausea and vomiting without fever, of several days of evolution, diagnosed with hepatic colic and managed conservatively.
Abdominal ultrasound and computed tomography (CT) were performed due to persistent pain, as well as uncomplicated cholelithiasis and the presence of free fluid perihepatic, peri splenic, paracoccal and pelvic.
With the diagnosis of acute abdomen, exploratory laparotomy was performed, free seropurulent fluid in the peritoneal cavity and a 5 mm perforation in the right lateral wall of the neobladder.
The lesion was sutured and reinforced with a major omentum flap.
Postoperative period complicated by aspiration with hemodynamic instability requiring semicritical care.
Upon discharge, a program of self-catheterization with scarce post-void residual was started.
Three years later (September 2004), the patient developed abdominal pain, peritonitis and paralytic ileus shortly after getting up in the morning, as well as decreased diuresis without fever.
She suffered from self-catheterization the night before, without difficulty, pain or hematuria.
The analytical shows Hb 156 g/l, leukocytosis 16.2 g/l (6 segmented) plus left shift, INR 0.97, Na 141 mmol/l, K 3.9 mmol/l, Creatinine 11.74 mmol/l
Abdominal CT showed abundant free peritoneal fluid and rupture of the neobladder with contrast extravasation.
A urinary catheter was placed, obtaining 800 cc of urine and diagnostic paracentesis was performed with biochemistry compatible with urine.
The culture was positive for E. Coli, sensitive to amoxicillin-clavulanic acid and aztreonam.
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Given the hemodynamic stability of the patient and the short time of evolution of the process, conservative treatment is performed, placing bilateral nephrostomy tubes (FNS), continuous peritoneal drainage with 6F pigtail and bladder catheter.
In addition, broad-spectrum antibiotic treatment was initiated (amoxicillin-clavulanic 1gr/ev/ 8h and aztreonam 1gr/ev/12h).
The clinical and laboratory evolution was satisfactory.
A week later, a filling cystography was performed. The patient reported a large capacity neobladder, bilateral reflux and absence of contrast extravasation; the catheter was removed later and 7 days later.
A daily self-catheterization program was started, showing low post-voidance residualism confirmed by serial ultrasound.
