Cesarean bladder injury - obstetrician's nightmare

Abstract

Urinary bladder is an adjacent viscus susceptible for intraoperative injury during cesarean section (CS). Prolonged labor, scarred uterus, intraabdominal adhesion, emergency CS, advanced labor, cesarean hysterectomy etc., are the predisposing factors for bladder injury during CS. While operating on such conditions, one should be meticulous to explore the possibility of bladder injury. Family physician practicing community obstetrics should be aware of this and know how to tackle this. Usually the dome of the bladder is injured and the trigonal area remains away from the injury field by 6-10 cm. Bladder rent is repaired in two layers either by continuous simple or interrupted suture with 3-0 & 2-0 polyglycolic acid suture. Suprapubic cystostomy and transurethral catheter are kept for 10-14 days. While postoperative adhesion, CS during full dilatation of cervix, abnormal anatomy etc., may not proceed for negligence, bladder injury in normal patients and unrecognized intraoperative bladder injury may attract penalty from the consumer court.

Keywords: Cesarean section; injury; layer repair; medico-legal; urinary bladder.

Figure 1

Bladder injury repair done by simple continuous suturing with polyglycolic acid suture. First layer is bladder mucosa and muscularis layer (3-0) and second layer is serosa (2-0). Mucosa pierced through-&-through. Repair can be done by interrupted suturing also