Bladder injuries following inguinal canal surgery in infants

Surgery of the inguinal canal is very common in infancy. Occasionally, injury of the bladder may occur with severe consequences. The aim of this paper was to warn young surgeons of this serious complication.

During the last 2 years, we observed four cases of bladder injury following surgery on inguinal canal. All were males. The indication for surgery was inguinal hernia in three patients and cryptorchidism in one patient.

Two cases presented with urinary peritonitis. One child was referred later for a retracted bladder with reflux. In one child, the lesion was promptly recognized and repaired. Of the four cases, two ruptures of the bladder caused transient sequaele, i.e. persisting catheter drainage, and voiding disorders later. In two cases, there were serious consequences: the bladder had to be partially removed in one child, ending up in temporary ureterostomy and subsequent reconstruction with bladder augmentation. The fourth child developed a small, water clock-shaped bladder with a thick wedge of scarred tissue, and bilateral ureteral reimplantation with bladder augmentation was necessary.

Surgery of the inguinal canal is very common in children and infants, and is often performed by trainees. Awareness of this serious event should be emphasized in training programs.