Urinary Peritonitis due to Unrecognized Bladder Injury During Laparoscopy: A Case Report
Bibliographic record
Abstract
Bladder injury is a possible complication of laparoscopic surgery. If it is not identified, the subsequent clinical presentation is usually unclear and confusing. We report the case of a 31-year-old patient without an obstetric history. A laparoscopic ovarian cystectomy was performed and a bladder perforation due to the use of an accessory suprapubic trocar must have occurred. However, the perforation was not identified as such during the operation nor in the postoperative period. This injury subsequently caused unclear symptoms with diffuse and persistent abdominal pain, sometimes intense and focused on the right side, in the days following the surgery. The observation of the globe of the Foley catheter with trasvaginal ultrasound in an extravesical location suggested bladder injury with spilling of the urine and catheter into the peritoneal cavity. An immediate laparotomy was performed, revealing a small bladder perforation on the front pre-peritoneal face and another 1-cm perforation in the upper part of the bladder that were corrected. Post-surgical progress was then normal. A high urachal vesical extension or filled bladder, no visual control or a too-low introduction of the suprapubic trocar can produce an unrecognised bladder perforation. Attention must be paid to irritating and persistent abdominal pain of urinary peritonitis, presumed anuria corrected after the positioning of the Foley catheter, variable haematuria, leukocytosis, and eventual electrolytic alterations without fever. The key to the diagnosis of bladder injury is awareness of this clinical entity. doi: http://dx.doi.org/10.4021/wjnu83e
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.004 | 0.003 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.005 | 0.003 |
| Science and technology studies | 0.004 | 0.003 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.010 | 0.005 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".