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Foreign Body Migration from the Bladder
Vol. 115, May Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright © 1976 by The Williams & Wilkins Co.
FOREIGN BODY MIGRATION FROM THE BLADDER TADAO KIRIYAMA, ITSUYA MOTONAGA
AND
TETSUYA ICHIKAWA
From the Department of Urology, Yamaguchi University Medical School, Ube, Yamaguchi, Japan
ABSTRACT
Because of the unusual route 2 cases of foreign body migration from the bladder are reported. In 1 case a thermometer was inserted into the bladder and penetrated into the peritoneal cavity. In the other case a thermometer penetrated from the bladder into the prevesical space. These penetrations occurred without any obvious manifestations after the thermometers were inserted into the bladder. It is not unusual to see patients with foreign bodies in the bladder. The literature abounds with cases of foreign objects recovered from the bladder, many of which have been laboriously introduced manually through the urethra. Uncommonly, other objects such as surgical materials or orthopedic hardwares have reached the bladder by migration from adjacent structures. Ingested foreign objects, especially fish bones, may even enter the bladder from the gastrointestinal tract by way of the gastrointestinal wall. On the other hand, penetration of a foreign object from the bladder into an adjacent structure, other than retrograde migration to the ureter, is almost unknown. Therefore, it is unusual to find cases similar to the 2 presented herein, in which thermometers initially lodged in the bladder migrated to the peritoneal cavity and the prevesical space.
as a means of sexual gratification. Since that time the patient had had constant discomfort in the suprapubic region, associated with dull pain at the termination of urination. Physical examination was essentially normal. Urinalysis revealed numerous white blood cells and a few red blood cells. A urine specimen yielded 2.3 times 10 7 colonies of enterococcus per ml. A plain film of the pelvic region suggested that the thermometer was obliquely positioned in the bladder. Further urographic and cystoscopic evaluations were not done because of the pregnancy. An obstetrician recommended administration of progesterone and piperidolate for several days as an abortive preventative. On August 30 the bladder was opened through a median incision in the lower abdomen. It looked quite normal and had no evidence of penetration. The thermometer was not found. A
A, plain film of kidneys, ureters and bladder shows thermometer vertically located to left of vertebral column. B, at operation thermometer was found to right of descending colon, enveloped by greater omentum. CASE REPORTS
Case 1. A 27-year-old housewife who was 4 months pregnant, YU 48-1182, was admitted to the hospital on August 22, 1973 for removal of a foreign body from the bladder. About 14 hours previously a thermometer had been inserted into the bladder Accepted for publication September 26, 1975.
530
plain film of the kidneys, ureters and bladder revealed that the thermometer was vertically located left of the vertebral column between the upper margin of the 4th lumbar vertebra and the lower end of the iliosacral joint (part A of figure). Since we thought that the thermometer had passed into the left ureter, similar to a case reported by Ficara and Properz, 1 we extended the incision upward and explored the left retroperitoneal space. The thermometer was not located. Because of the possibility
FO::O:E,GN BODY MIGRATION FROM BLADDER
that the film had been reversed the retroperitoneal space and the right ureter were exµHJitu also unsuccessfully. Therefore, the peritoneum was opened. The greater omentum had become lumped together between the descending colon and the ascending segment of the sigmoid colon, and the lowest part had become attached to the dome of the bladder. The thermometer was to the right of the descending colon, enveloped by the greater ornentum (part B of figure). Convalescence was uneventful. Case 2. A 33-year-old housewife, SN 49-573, was seen on May 8, 1974 with vague complaints but she would not elaborate upon them. There was moderate tenderness in the suprapubic region. Urinalysis revealed many white blood cells and a few red blood cells. A cystoscopic evaluation disclosed that a thermometer was end-to-end in the bladder. The thermometer
was demonstrated in the pelvic region on a film of the kidneys, ureters and bladder. The patient then confided that the thermometer had been introduced into the bladder by her husband on the previous night. An operation performed the next day revealed that the sharp end of the thermometer had penetrated the anterior wall of the bladder and half of the thermometer was lodged in the prevesical space just below the abdominal musculature extraperitoneally. The rest of the thermometer had remained free in the bladder. The thermometer was withdrawn with a little flow of urine from the bladder. Convalescence was uneventful. REFERENCE 1. Campbell, M. F. and Harrison, J. H.: Urology, 3rd ed. Philadelphia:
W. B. Saunders Co., p. 778, 1970.
THE JOURNAL OF UROLOGY
Copyright © 1976 by The Williams & Wilkins Co.
FOREIGN BODY MIGRATION FROM THE BLADDER TADAO KIRIYAMA, ITSUYA MOTONAGA
AND
TETSUYA ICHIKAWA
From the Department of Urology, Yamaguchi University Medical School, Ube, Yamaguchi, Japan
ABSTRACT
Because of the unusual route 2 cases of foreign body migration from the bladder are reported. In 1 case a thermometer was inserted into the bladder and penetrated into the peritoneal cavity. In the other case a thermometer penetrated from the bladder into the prevesical space. These penetrations occurred without any obvious manifestations after the thermometers were inserted into the bladder. It is not unusual to see patients with foreign bodies in the bladder. The literature abounds with cases of foreign objects recovered from the bladder, many of which have been laboriously introduced manually through the urethra. Uncommonly, other objects such as surgical materials or orthopedic hardwares have reached the bladder by migration from adjacent structures. Ingested foreign objects, especially fish bones, may even enter the bladder from the gastrointestinal tract by way of the gastrointestinal wall. On the other hand, penetration of a foreign object from the bladder into an adjacent structure, other than retrograde migration to the ureter, is almost unknown. Therefore, it is unusual to find cases similar to the 2 presented herein, in which thermometers initially lodged in the bladder migrated to the peritoneal cavity and the prevesical space.
as a means of sexual gratification. Since that time the patient had had constant discomfort in the suprapubic region, associated with dull pain at the termination of urination. Physical examination was essentially normal. Urinalysis revealed numerous white blood cells and a few red blood cells. A urine specimen yielded 2.3 times 10 7 colonies of enterococcus per ml. A plain film of the pelvic region suggested that the thermometer was obliquely positioned in the bladder. Further urographic and cystoscopic evaluations were not done because of the pregnancy. An obstetrician recommended administration of progesterone and piperidolate for several days as an abortive preventative. On August 30 the bladder was opened through a median incision in the lower abdomen. It looked quite normal and had no evidence of penetration. The thermometer was not found. A
A, plain film of kidneys, ureters and bladder shows thermometer vertically located to left of vertebral column. B, at operation thermometer was found to right of descending colon, enveloped by greater omentum. CASE REPORTS
Case 1. A 27-year-old housewife who was 4 months pregnant, YU 48-1182, was admitted to the hospital on August 22, 1973 for removal of a foreign body from the bladder. About 14 hours previously a thermometer had been inserted into the bladder Accepted for publication September 26, 1975.
530
plain film of the kidneys, ureters and bladder revealed that the thermometer was vertically located left of the vertebral column between the upper margin of the 4th lumbar vertebra and the lower end of the iliosacral joint (part A of figure). Since we thought that the thermometer had passed into the left ureter, similar to a case reported by Ficara and Properz, 1 we extended the incision upward and explored the left retroperitoneal space. The thermometer was not located. Because of the possibility
FO::O:E,GN BODY MIGRATION FROM BLADDER
that the film had been reversed the retroperitoneal space and the right ureter were exµHJitu also unsuccessfully. Therefore, the peritoneum was opened. The greater omentum had become lumped together between the descending colon and the ascending segment of the sigmoid colon, and the lowest part had become attached to the dome of the bladder. The thermometer was to the right of the descending colon, enveloped by the greater ornentum (part B of figure). Convalescence was uneventful. Case 2. A 33-year-old housewife, SN 49-573, was seen on May 8, 1974 with vague complaints but she would not elaborate upon them. There was moderate tenderness in the suprapubic region. Urinalysis revealed many white blood cells and a few red blood cells. A cystoscopic evaluation disclosed that a thermometer was end-to-end in the bladder. The thermometer
was demonstrated in the pelvic region on a film of the kidneys, ureters and bladder. The patient then confided that the thermometer had been introduced into the bladder by her husband on the previous night. An operation performed the next day revealed that the sharp end of the thermometer had penetrated the anterior wall of the bladder and half of the thermometer was lodged in the prevesical space just below the abdominal musculature extraperitoneally. The rest of the thermometer had remained free in the bladder. The thermometer was withdrawn with a little flow of urine from the bladder. Convalescence was uneventful. REFERENCE 1. Campbell, M. F. and Harrison, J. H.: Urology, 3rd ed. Philadelphia:
W. B. Saunders Co., p. 778, 1970.