Foreign Body Inside the Urinary Bladder

Foreign body inside the Urinary Bladder- A Case Report

Wooden Foreign body inside the Urinary Bladder

Case Capsule

70 year old male patient, presented to the emergency surgical  department with history of accidental fall  over a wooden piece .

 With complaints of pain in the lower abdomen and wound over the peri anal region.

 On admission patient was hemodynamicaly stable.

He did not pass urine since the event.

No associated  bleeding per meatus or fecal incontinence

Per Abdomen: showed diffused lower abdominal tenderness.

 No rigidity noted.

Bladder not palpable per abdomen.

Local Examination

  Lacerated wound over the perianal region at 7’o clock position measuring approx 4 x 2 cm extending to the anterior rectal wall.

Digital Rectal Examination

 Lax sphincter tone

Approx 5 cm linear defect palpated over the anterior rectal wall starting approx about 2cm from the anal verge, communicating with external perianal wound.

With fecal contamination of the perianal wound noted.

CT scan taken revealed :

Rectovesical fistula tract extending from the perianal external wound to the base of the bladder.

Linear tear involving the anterior rectal wall.

Tear involving the base of the bladder.

Foreign body inside the bladder.

Urology consulatation was taken and planned for cystostomy and evacuation of the vesical foreign body.

Patient was posted for the emergency surgery.

Intra op findings and the Procedure

A linear tear of the anterior rectal wall was noticed starting approximately  2cm from the anal verge.

 With a full thickness rectal rent noted in its most proximal portion of the tear just below the peritoneal reflection communicating with the base of the bladder.

Tear involving the base of the bladder measuring approx 1 x 0.5 cm just above the inter ureteric ridge noted.

Wooden piece noted with in the bladder cavity, which was extracted.

Bilateral ureteric orifice normal.

Bilateral  DJ stenting done.

Vesical tear closure done.

SPC  done.

Vertical cystostomy closure done.

Rectum mobilised and primary repair  of the rectal tear done.

Diversion clostomy done via sigmoid loop colostomy.

Perianal wound was kept open.

Post Operative Period 

Post op period was uneventful.

Was started on enteral feeds on the post operative day 2.

Was discharged onpost operative day 12 with insitu spc and uretheral catheter.

                                        Courtesy : Dr Mohammed Jashin