bladder perforation in childhood is rare , accounting for only 0.05 - 2.0% of all pelvic trauma cases . in children of a younger age , the bladder is located somewhat intraperitoneally , making it vulnerable to perforation when full at the time of trauma . blunt injury is more common in patients with bladder perforation ( greater than 80 - 95% ) . the bladder dome is the most common perforation site and is also the weakest point . before the introduction of laparoscopy , open surgery was the only treatment option for adults and children with intraperitoneal bladder perforation . to our knowledge , laparoscopic repair of traumatic bladder perforation in children has not been reported in the literature . this present report discusses the laparoscopic repair of traumatic bladder perforation due to blunt abdominal trauma in two children . a 3-year - old boy who was involved in a road accident presented with a pelvic fracture and skin abrasion on the right inguinal region . a cystography was performed 36 h after admission due to persistent haematuria , revealing an intraperitoneal bladder perforation . a laparoscopy was carried out with a 5-mm 30 telescope through the navel and two additional 3-mm ports . a 3-cm long intraperitoneal bladder perforation was identified . using 3 - 0 polyglactin running sutures , the post - operative period was uneventful and the patient was discharged on post - operative day 5 . a cystography was done due to haematuria and an intraperitoneal bladder perforation was discovered . on laparoscopy , a 3-cm vertical bladder perforation was found and repaired in two layers with 3 - 0 ethibond excel(somerville , nj , usa ) running sutures using an intracorporeal suturing technique [ figure 1a  c ] . the post - operative course was uneventful and the boy was discharged on post - operative day 6 . stages of the bladder repair ( a ) perforation on the bladder ( b ) suturing of the perforation site and ( c ) completed repair a 3-year - old boy who was involved in a road accident presented with a pelvic fracture and skin abrasion on the right inguinal region . a cystography was performed 36 h after admission due to persistent haematuria , revealing an intraperitoneal bladder perforation . a laparoscopy was carried out with a 5-mm 30 telescope through the navel and two additional 3-mm ports . a 3-cm long intraperitoneal bladder perforation was identified . using 3 - 0 polyglactin running sutures , the post - operative period was uneventful and the patient was discharged on post - operative day 5 . a 3-year - old boy fell from a second storey building onto hard ground . the child presented with a pelvic fracture and abdominal skin abrasions . a cystography was done due to haematuria and an intraperitoneal bladder perforation was discovered . on laparoscopy , a 3-cm vertical bladder perforation was found and repaired in two layers with 3 - 0 ethibond excel(somerville , nj , usa ) running sutures using an intracorporeal suturing technique [ figure 1a  c ] . the post - operative course was uneventful and stages of the bladder repair ( a ) perforation on the bladder ( b ) suturing of the perforation site and ( c ) completed repair intraperitoneal bladder perforation is rare in children but it is more common than in adults . blunt injury of the urinary bladder is well - known and usually associated with pelvic fractures . regional trauma signs such as skin abrasions and abdominal distension are also common . in case 2 , gross haematuria was present as an initial sign ; thus , diagnosis was done early . however , in case 1 the patient had no gross haematuria and the ct examination did not reveal the perforation ; moreover , the urinary catheter was inserted early on allowed urine drainage , making the symptoms of intraperitoneal leak subtle , which led to a delayed diagnosis . the diagnosis of bladder perforation is confirmed with regular cystography or ct - assisted cystography . the contrast medium should be filled slowly and anterior - posterior ( ap ) and oblique x - rays should be obtained . therefore , an x - ray after emptying should also be obtained . for the diagnosis , quagliano et al . found no difference in sensitivity and specificity between conventional cystography and ct - assisted cystography in the diagnosis of traumatic bladder perforation . they recommended ct cystography in patients with blunt abdominal trauma and the suspicion of bladder perforation . in case 1 , the ct cystography failed to show the bladder perforation accurately since , we think , the bladder was empty and the contrast medium did not reach the bladder during the ct examination . perforation , drainage with a urinary or suprapubic catheter is sufficient . in contrast , intraperitoneal bladder perforation requires surgical repair . although some investigators suggest conservative treatment in intraperitoneal bladder perforation , surgery is the method of choice in the current literature . the type of surgery for intraperitoneal bladder perforation is classical open repair . in the opinions of the authors , laparoscopic repair is a reasonable alternative to laparotomy . in trauma patients , laparoscopy is sometimes challenging or contraindicated . intestinal dilatation , intraperitoneal bleeding and massive intraperitoneal fluid in trauma may deteriorate vision and lead to difficulties in surgery . therefore , some conditions must be met before a laparoscopy in trauma is performed . the first successful laparoscopic repair of an iatrogenic bladder perforation was performed in 1990 and in 1997 , the first traumatic bladder perforation was repaired by laparoscopy . in the literature , there are 10 cases of laparoscopic repair of traumatic bladder perforation . recent literature revealed eight articles with laparoscopic bladder perforation solely in adults . according to these studies , the length of perforation was usually less than 4 cm and there was no difference between single- and double - layer repairs . whatever the surgical technique , checking for leaks by means of filling the bladder , as was performed in cases 1 and 2 , is mandatory . to our knowledge , cases 1 and 2 represent the first cases of laparoscopic repair of traumatic bladder perforation in children . in conclusion , laparoscopic repair of traumatic bladder perforation is a reliable alternative to open technique in stable patients unless there is bladder neck injury or inaccessible sites of bladder injury . for repair , single- or laparoscopy provides diminished post - operative pain , shortened length of stay and cosmetic superiority .
here , we report two patients with a traumatic intraperitoneal bladder dome rupture repaired by laparoscopic intracorporeal sutures . the first patient was a 3-year old boy was admitted with a history of road accident . he had a traumatic lesion on his lower abdomen and a pelvic fracture . computed tomography ( ct ) 
 scan revealed free intraabdominal fluid . 
 the urethragram showed spreading contrast material into the abdominal cavity . 
 laparoscopic exploration revealed a 3-cm - length perforation at the top of the bladder . 
 the injury was repaired in a two fold fashion . 
 post - operative follow - up was uneventful . 
 the second case was a 3-year - old boy fell from the second floor of his house on the ground . 
 he had traumatic lesion on his lower abdomen and a pelvic fracture . 
 due to bloody urine drainage , a cystography was performed and an extravasation from the dome of the bladder into the peritoneum was detected . 
 on laparoscopy , a 3-cm long vertical perforation at the dome of the bladder was found . 
 the perforation was repaired in two layers with intracorporeal suture technique . 
 the post - operative course was uneventful . 
 laparoscopic repair of traumatic perforation of the bladder dome is a safe , effective and minimally invasive method . 
 the cosmetic outcome is superior .