WOFAPS 2025 8th World Congress of Pediatric Surgery

Maximiliane Minderjahn, Anja Lingnau

Charité Universitätsmedizin Berlin

We present a case of a premature infant referred to our hospital after undergoing elective surgery for inguinal hernia at 49 weeks gestational age. According to records open inguinal herniotomy was performed without intraoperative complications. After showing exacerbation of pain, as well as distension of the abdomen, anuria and ascites two revision-surgeries were performed for suspected bladder perforation. The perforation was reconstructed using a peritoneal patch, in a second revision bilateral percutaneous nephrostomies were placed and the child was reffered to out centre for further urological evaluation.

We saw a preterm neonate in septic condition due to septic uroascites and subsequently peritonitis. Cultures showed Klebsiella oxytoca in peritoneal fluid. We started antibiotic treatment with Tazobactam and initiated further imaging. Cystography through the urethral catheter showed prompt leakage at the inguinal incision without contrasting a bladder, confirming indication for revision surgery. After reopening of the incision we found the bladder trigonum with tachosil patches attached, covered by inflamed small intestine. After removal of the patches, we could not identify any residual bladder aside from the trigonum with both orifices and the urethral catheter ending freely in the peritoneum. On the left side residual of the sperm duct appeared to be intersected.

We performed open ureteroileocutaneostomy in form of a incontinent conduit using Wallace technique. Postoperative management was prolonged due to the peritonitis. Serum-creatinine was standard level throughout treatment. The child was discharged after 9 days with sufficient diuresis over the conduit. Aftercare involved regular out-patient ultrasounds. Patient is currently stable and thriving. Parents have been informed about possible diversion surgery in the future.