Clinical Presentation & History
A 68-year-old male undergoing transurethral resection of a bladder tumor who develops sudden abdominal distension, falling oxygen saturation, and rising airway pressures under general anesthesia.
Emergency Resuscitation
Urology
IC-EM-00550
Intermediate Level
Intraoperative Bladder Perforation During Transurethral Tumor Fulguration
Intraoperative Bladder Perforation During Transurethral Tumor Fulguration - Urology clinical simulation case. A 68-year-old male undergoing transurethral...
Age: 68 • Gender: Male • Setting: Emergency Triage
Acute Resuscitation Milestones & Priorities
Clinical phases and key interventions encountered in this emergency module:
- Intraoperative Crisis Recognition & Anesthetic Alert
- Hyponatremia, TUR Syndrome & Hemodynamic Support
- Decompressive Laparotomy & Bladder Repair
- Postoperative ICU, Abdominal Compartment Syndrome & Disposition
High-Yield Clinical Pearls
Intraperitoneal bladder perforation during TURBT presents with abdominal distension, rising airway pressures, and acute hyponatremia from glycine absorption; the differential is short: extraperitoneal rupture, TUR syndrome without perforation, or bowel injury from obturator nerve stimulation.
Severe symptomatic hyponatremia (Na < 120 mmol/L with neurologic or cardiac findings) warrants 100 mL of 3% hypertonic saline; correction must not exceed 8–10 mmol/L per 24 hours to avoid osmotic demyelination.
An intra-abdominal pressure ≥ 20 cm H2O with new organ dysfunction defines abdominal compartment syndrome and mandates decompressive laparotomy.
Intraperitoneal bladder rupture requires two-layer repair with suprapubic drainage and pelvic drainage; cystogram before catheter removal confirms watertight healing.
Low-grade Ta bladder cancer does not justify intraoperative radical cystectomy; staged re-resection and intravesical therapy remain the standard.