Unrecognized bladder perforation leading to severe progressive cellulitis and candidal infection.

Mar Apr 2012

Fenderson JL, Washington BB, Hampton BS, Myers D.

Source

Department of Obstetrics and Gynecology, Women & Infants' Hospital of Rhode Island, Providence, RI, USA. jfenderson@wihri.org

Abstract

BACKGROUND:

Retropubic midurethral slings are a minimally invasive surgical procedure used in the treatment of stress urinary incontinence and are typically associated with high cure rates and low complication rates. Bladder perforation is a known intraoperative complication that, if left unrecognized, can have significant morbidity.

CASE:

A 47-year-old underwent a retropubic midurethral sling, anterior colporrhaphy, and cystoscopy. She developed a suprapubic wound cellulitis that progressed to involve the right trunk and flank as well as persistent fever for more than 48 hours despite broad-spectrum antibiotics. Upon return to the operating room, the patient was found to have an unrecognized bladder perforation with mesh in the bladder. Wound culture was remarkable for Candida parapsilosis and Escherichia coli.

CONCLUSION:

Unrecognized bladder perforation and nonbacterial causes of infection should be considered in patients with severe progressing cellulitis despite broad-spectrum antibiotic coverage after retropubic midurethral sling placement.

Wolters Kluwer