Clinical case of abscess of the posterior wall of the urinary bladder in a 3-year-old patient. Diagnostic and treatment tactics

Abstract

Intra-abdominal inflammatory formations of the abdominal cavity in children are a complication of inflammatory processes of various organs, one of which may be the bladder. Untimely determination of the anatomical localization of the inflammatory focus is one of the reasons for the incorrect diagnosis, hypodiagnosis, and the choice of treatment tactics that are not radical in relation to the etiology of the disease.

Aim - description of symptoms, determination of diagnostic measures and complex treatment of abscess of the bladder wall in children based on a clinical case.

The clinical case demonstrates the tactics of diagnosis and treatment in a 3-year-old patient with an abscess of the posterior wall of the bladder. Analysis of the course of the disease and the diagnostic and treatment process proved the reasons for determining the incorrect diagnosis, improperly etiology and localization of the inflammatory focus, the dynamics of the course of the disease, and treatment tactics at the first stage of treatment, which became the reason for the untimely surgical intervention. The need for multimodal diagnostic tactics in the visualization of inflammatory formations of the abdominal cavity is determined and proven. The diagnostic value and feasibility of using additional examination methods are analyzed. Differential diagnosis of bladder wall abscess with urachus anomalies is presented. Conservative and surgical treatment tactics are determined.

Conclusions. The structure of inflammatory infiltrates/abscesses of the abdominal cavity in children is polyetiological. One of the causes of the occurrence of an infiltrate/abscess of the abdominal cavity is the inflammatory process of the bladder wall. The presence of an infiltrative formation of the abdominal cavity requires multimodal diagnostic tactics immediately after determining the diagnosis and hospitalization - performing magnetic-resonance imaging (if it is impossible to perform it - computed tomography with contrast) and ultrasound of the abdominal organs, in order to determine its etiology, localization, nature and structure of pathological changes, the possible presence of abscessation, location relative to other anatomical structures. The presence of an infiltrate/abscess of the bladder wall requires differential diagnosis with complicated anomalies of the urachus, other developmental defects, tumor-like formations. The presence of a bladder wall abscess in a pediatric patient is an indication for perfoming fibroureterocystoscopy under general anesthesia to determine possible presence of changes in the mucosa, congenital malformations, and tumor-like formations of the bladder.

The research was carried out in accordance with the principles of the Helsinki Declaration. Informed consent was obtained from parents of the child.

The authors declare no conflict of interest.