Bladder diverticulum/fistula after previous bladder cystectomy

Introduction: Bladder injury is a rare occurrence, because the bladder is located deep in the pelvis and is protected by the pelvis. With the increase of certain medical conditions, the risk of iat-rogenic vesico-peritoneal fistula is increasing; however, iatrogenic vesico-peritoneal fistulas in the pediatric population are rarely reported in the literature.Case report: Two girls presented to our department with acute abdominal pain and urinary ascites, and both of them had underdone partial bladder cystectomies approximately 1 year ago to treatment urachal cysts and ureteroceles. Bladder diverticula were observed during the cystos-copies. We hypothesized that the bladder diverticula developed from insecure sutures, and laparoscopic vesical diverticulectomies and cystorrhaphies were performed in these two patients.Discussion: A vesico-peritoneal fistula is a rare complication of partial bladder cystectomy, and vesico-peritoneal fistulas may cause acute abdominal pain and ascites that can lead to a misdi-agnosis. Micturating cystourethrograms (MCUG) and cystoscopies should be performed in pa-tients with abdominal pain and ascites who have previously had bladder surgery.Conclusion: Iatrogenic vesico-peritoneal fistulas in these patients might develop from insecure sutures. Care must be taken in suturing the bladder during bladder surgery to reduce this complication.