JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY
Online ISSN : 1884-5746
ISSN-L : 1884-9938
Elevated bladder margin after urachal surgery
Kimihisa TajimaIkuko UchinamiShin FukudaMakoto OrisakaFumikazu Kotsuji
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2008 Volume 24 Issue 2 Pages 392-395

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Abstract

A 13-year-old patient was admitted for laparoscopic resection of a right ovarian dermoid cyst. She had a history of a congenital patent urachus that connected the dome of the urinary bladder with the umbilicus. Excision of the urachus and umbilicoplasty was performed 4 days after birth. During the laparoscopic ovarian cystectomy, the first trocar was inserted in a supraumbilical incision using an open technique. Direct laparoscopic observation could not clearly identify the upper margin of the bladder. To lessen the risk of bladder injury, we distended the bladder with 300 ml of saline and identified the bladder margin. The dome of the bladder was significantly elevated, located 8.5 cm above the symphysis pubis and 4.5 cm below the umbilicus. Ancillary trocars were carefully inserted while keeping away from the bladder and the entire ovarian cyst was removed. When performing laparoscopic surgery in a patient who had congenital urachal anomalies, the dome of the urinary bladder can be unusually elevated and saline infusion may help in the identification of the bladder margin.

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© JAPAN SOCIETY OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY AND MINIMALLY INVASIVE THERAPY
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