Abstract

A female patient presented with a 5-day history of abdominal pain following a laparoscopic cholecystectomy and urachal cyst excision. The urinary bladder (UB) appeared normal in 2 consecutive CTs with contrast done at 2 different hospitals. When a careful history was taken and the patient’s operative file was reviewed, an iatrogenic UB injury was suspected. Then, the delayed CT images showed an iatrogenic UB injury. A diagnostic laparoscopy revealed a large UB tear measuring 7 cm - 8 cm, which was repaired in two layers. A urethral catheter was removed after 7 days without a cystogram. We want to advise medical professionals that a CT cystogram is the ideal imaging modality for detection of UB tears that may not be obvious in the routine CT, even with contrast. Alternatively, delayed films can be taken but seeing contrast in the abdominal and pelvic cavities may require a few hours before they become apparent.