Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Practice

Renal failure and ascites after remote laparoscopy

Samiran Adhikary, Prasad Mathews and Ganesh Gopalakrishnan
CMAJ November 22, 2005 173 (11) 1323; DOI: https://doi.org/10.1503/cmaj.050915
Samiran Adhikary
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Prasad Mathews
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ganesh Gopalakrishnan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Responses
  • Metrics
  • PDF
Loading

A previously healthy 38-year-old woman had undergone laparoscopic left ovarian cystectomy because of endometriosis. She had previously undergone 2 cesarean sections. Two months after the cystectomy, she had sudden onset of diffuse abdominal pain and distension as well as dysuria. Examination revealed no localized or peritoneal signs but did show substantial ascites. The laboratory test results were normal except for an elevated serum creatinine level (198 [normal < 133] μmol/L). Noncontrast CT scanning showed free fluid in her abdomen and a thickened omentum. One litre of straw-coloured ascitic fluid was aspirated; the leukocyte count was 0.50 [normal < 0.25] х 109/L (lymphocytes 55%, neutrophils 45%).

Tuberculosis of the abdomen was suspected. However, this diagnosis was unlikely because the ascites, dysuria and abdominal pain resolved spontaneously within 48 hours after aspiration of the ascitic fluid, and renal function returned to normal within 72 hours.

Figure1
  • Download figure
  • Open in new tab
  • Download powerpoint

Figure 1.

One month later the patient was reassessed and found to have ascites with generalized abdominal tenderness and guarding in the hypogastrium, which worsened over 24 hours. Oliguria (serum creatinine level 180 μmol/L) and, subsequently, anuria (serum creatinine level 675 μmol/L) developed. A catheter was inserted, and brisk diuresis of more than 5 L resulted in her renal function rapidly returning to normal. The creatinine level of the ascitic fluid was grossly elevated (2178 μmol/L), which confirmed the diagnosis of urinary ascites. Ultrasonography revealed kidneys of normal size, and noncontrast CT scanning did not show obvious bladder injury but did reveal a fat density lesion in the bladder. Contrast-enhanced CT scanning showed normal kidneys and ureters and a tongue of fat, probably omental tissue, adherent to the anterior wall of the bladder. CT cystography did not reveal any urinary leak. Cystoscopy, performed to identify the bladder perforation, revealed that omentum was plugging the defect at the dome of the bladder (Fig. 1). Laparotomy was performed to close the bladder perforation, and the patient had an uneventful recovery.

Bladder injury is a known complication of gynecologic laparoscopic surgery, occurring in up to 8.3% of cases,1 and is more common in women who have undergone previous pelvic operations. The diagnosis of accidental intraperitoneal bladder injury may be delayed2 if the injury is trivial or if omentum plugs a larger defect, as was seen in our case. Unexplained ascites and decreased renal function in a previously healthy person with a recent history of pelvic surgery should raise the suspicion of intraperitoneal bladder rupture. Our patient's first episode of ascites resolved without treatment, probably because of spontaneous evacuation of urine through the bladder defect. A very high creatinine level in the ascitic fluid is diagnostic.3 Treatment should involve conventional or CT cystography to localize the bladder perforation, followed by laparotomy to repair it.

REFERENCES

  1. 1.↵
    Ostrzenski A, Ostrzenska KM. Bladder injury during laparoscopic surgery. Obstet Gynecol Surv 1999;54(11):233-8.
    OpenUrl
  2. 2.↵
    Lamaro VP, Broome JD, Vancaillie TG. Unrecognized bladder perforation during operative laparoscopy. J Am Assoc Gynecol Laparosc 2000;7(3):417-9.
    OpenUrlPubMed
  3. 3.↵
    Heyns CF, Rimington PD. Intraperitoneal rupture of the bladder causing the biochemical features of renal failure. Br J Urol 1987;60(3):217-22.
    OpenUrlPubMed
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 173 (11)
CMAJ
Vol. 173, Issue 11
22 Nov 2005
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Renal failure and ascites after remote laparoscopy
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Renal failure and ascites after remote laparoscopy
Samiran Adhikary, Prasad Mathews, Ganesh Gopalakrishnan
CMAJ Nov 2005, 173 (11) 1323; DOI: 10.1503/cmaj.050915

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Renal failure and ascites after remote laparoscopy
Samiran Adhikary, Prasad Mathews, Ganesh Gopalakrishnan
CMAJ Nov 2005, 173 (11) 1323; DOI: 10.1503/cmaj.050915
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • REFERENCES
  • Figures & Tables
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • “Superscan” in diffusion-weighted imaging with background body suppression magnetic resonance imaging
  • Using intranasal corticosteroids
  • Langerhans cell histiocytosis in a 5-month-old baby
Show more Practice

Similar Articles

Collections

  • Topics
    • Urology
    • General surgery

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

Powered by HighWire