Rupture of Urinary Bladder As
a
Complication of
Umbilical
Artery Cutdown
S. Hossein Fakhraee, M.D., David R. Krauss, M.D.
UMBILICAL
ARTERY CATHETERestablished procedure very care of the sick newborn. However, it may be associated with numerous complications and technical problems. 1.2 There are occasions when the umbilical artery cannot be successfully catheterized by conventional methods. In such instances, alternative procedures including umbilical artery cutdown have been employed .3-5 A complication of umbilical artery cutdown which was encountered in our neonatal intensive care unit is discussed. IZATION is useful in the
Case
an
Report
The baby girl was the 1560 g, twin B, product a 32-week uncomplicated gestation, born to a 22-year-old gravida 2, para 1, mother. Labor and delivery were unremarkable. The Apgar scores at one and five minutes of life were 6 and 7 respectively. Shortly after birth, the infant was noted to be in respiratory distress. Several unsuccessful attempts were made to insert an umbilical artery catheter. Finally., an umbilical artery cutdown was
of
infraumbiiical incision. During the procedure, the peritoneal space was inadverteiitiv entered. The peritoneum was sutured without any obvious complications. During the third day of life, the urine output began to de-
performed. through
an
The patient was seen by a urologist and a catheter inserted into the I~lacider. Injection of dye through the urethral catheter revealed free com~nunieatic~n between the bladder and peritoneal space. The baby’s condition progressively worsened and on the fifth day of life she died. At autopsy, there was a small laceration at the dome of the bladder with free communication between the bladder and peritoneal space. An i~~traventricu~ar hemorrhage and hyalin~ membrane disease were also discovered. crease.
Comment In this report, we present a case of rupture of the bladder with development of a cystoperitoneal fistula as a complication of umbilical artery cutdown. This has not been reported previously. Umbilical artery cutdowns should be performed by experienced physicians and all structures should be carefully identified when performing the procedure.
References 1. Cockran WD, Davis HT, Smith CA: Advantages and complications of umbilical artery catheterizations in the newborn. Pediatrics 42:769, 1968 2. Kitterman JA, Phibbs RH, Tooley WH: Catheterization of umbilical vessels in newborn infants. Pediatr Clin North Am 17:895, 1970 3. Sherman NJ: Umbilical artery cutdown. J Pediatr
Surg 12:723,1977
From the Scott and White Clinic, Temple, Texas. Present Address: St. Louis Children’s Hospital, Department of Pediatrics, 500 S. Kingshighway, St. Louis, MO 63178 (correspondence). Received for publication September, 1978; accepted February, 1979.
4. Clark JM, Jung AL: Umbilical artery catheterization by cutdown procedure. Pediatrics 59 (Suppl):
1036, 1977 5. Moor TC, Leake RD: Infraumbilical entry into the peritoneal cavity througha small incision for the identification and cannulation of an umbilical
artery. J Pediatr Surg 12:247, 1977
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