Bladder trauma is caused by a direct blow to the distended bladder, severe injury fracturing the pelvis, iatrogenic, or penetrating wounds. Early detection and diagnosis are key to successful management of cases, but omission or late reveal of bladder damage increase mortality and create long-term problems. A bladder injury may not always present with immediate obvious signs and symptoms, especially in a multi-trauma patient, who is also more difficult to investigate. Moreover, during the COVID-19 pandemic, delayed patients’ access to tertiary, multidisciplinary hospitals, increases the risk for delayed diagnosis and also increases the need for more specialists from different surgical and non-surgical areas to raise their awareness of less common manifestations of bladder trauma. We present a review of literature and cases of less common bladder damage from the perspective of a multi-disciplinary team in the University Emergency Hospital in Bucharest.
Single ventricle heart (SVH) is a very rare congenital heart disease. However, since the introduction of Fontan's intervention, the survival rate of patients with SVH has been significantly improved, increasing the number of women who may become pregnant in this condition. It has been already reported, in isolated case presentations or in some series of patients, that the pregnacy in the context of SVH and Fontan circulation carries a very high risk for first trimester miscarriage, maternal cardiovascular or obstetric complications and for an increased rate of pre-term birth. Therefore, it is an open field of debate weather or not to allow pregnancy in this category of patients. We are presenting the case of a 22 years old patient who underwent two surgeries for SVH: a Glenn procedure when she was 2 years old and the implantation of a Fontan circuit at the age of 16 years. Since the last surgery she was under permanent internal cardiac stimulation. During the pregnancy the patient was hemodynamically stable, with a normal resting oxygen saturation and a good ejection fraction of the single ventricle. However, the evolution of this patient has become even more challenging due to an aberrant praevia placental lobe. This condition brought her to hospital for several episodes of metrorrhagia and uterine contractions. She delivered at 33 weeks of gestation by emergency Caesarian section with a good evolution until discharge, for mother and the newborn. This case is supporting the opinion that pregnancy can be tolerated without important cardiovascular events in patients with SVH and Fontan circulation, unless heart failure or cardiac arrythmia are associated. Nevertheless, the obstetrical complications remain an important problem in pregnancy overcome of patients with Fontan circulation for SVH that can be superimposed with other unfavorable conditions, like aberrant praevia placental lobe in this case. During the management of such particular clinical settings difficult decisions must be taken, including those addressing the antithrombotic therapy that will be covered in the presentation of this case.
