SPONTANEOUS BLADDER PERFORATION IN PARAPLEGIA AS A LATE COMPLICATION OF AUGMENTATION ENTEROCYSTOPLASTY - CASE-REPORT

The management of spinal cord injured (SCI) patients with small capaci ty, noncompliant bladders has focused on the preservation of renal fun ction and social continence. When conservative management is unsuccess ful, surgical intervention may prove beneficial. Augmentation enterocy stoplasty is a reliable method of achieving increased bladder capacity while decreasing intravesical filling pressure. Spontaneous bladder r upture is a rare complication of augmentation enterocystoplasty. Becau se the urine is often colonized with bacteria, bladder rupture may res ult in chemical and bacterial peritonitis, which is associated with a 25% mortality rate. SCI patients may not present with the classic sign s of an acute abdomen. Early diagnosis is critical so that aggressive management may be instituted. The case of late spontaneous perforation of an augmentation enterocystoplasty in a 33-year-old man with T7 com plete paraplegia is presented, and the literature discussing the etiol ogy, diagnosis, management, and prevention of augmented bladder perfor ation is reviewed. (C) 1996 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilita tion