Spontaneous bladder rupture following augmentation enterocystoplasty.

Spontaneous bladder rupture following enterocystoplasty has been reported recently. The etiology remains unclear but appears to be multifactorial. The common factors among the reported patients are a high outlet resistance with total urinary continence and the presence of an augmented, dysfunctional native bladder. This combination may result in the development of high intravesical pressures or increased wall tension through several mechanisms, including over-filling and active contraction in the bowel or detrusor. The presence of an abnormal detrusor may cause the wall tension to be unevenly distributed toward the bowel segment. Diagnosis requires a high degree of suspicion and prompt laparotomy with closure of the defect. Prevention depends on maintaining low bladder volumes and, thus, pressures.