{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T11:24:34Z","timestamp":1785324274211,"version":"3.55.0"},"reference-count":15,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,3,23]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:p>We present a case of a man in his late 70s with a history of peritonitis and vesical stones who developed severe complications after undergoing the transurethral resection of a bladder tumour (TURBT) followed by immediate mitomycin C (MMC) instillation. The patient experienced abdominal pain and haematuria and was subsequently diagnosed with pancytopenia and extraperitoneal bladder rupture. He later developed a urinary tract infection, leading to methicillin-resistant <jats:italic>Staphylococcus aureus<\/jats:italic>-related septic pulmonary embolism (SPE). Despite intensive care efforts, his condition deteriorated, culminating in discharge for impending death.<\/jats:p>\n               <jats:p>Pancytopenia and SPE represent rare but severe complications associated with post-TURBT immediate intravesical MMC instillation. Clinicians must be vigilant for symptoms of bladder perforation and consider deferring to chemotherapy in such cases.<\/jats:p>","DOI":"10.1136\/bcr-2025-265360","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T16:25:18Z","timestamp":1744734318000},"page":"e265360","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Rare complications of bladder perforation following the transurethral resection of a bladder tumour with the immediate intravesical instillation of mitomycin C"],"prefix":"10.1136","volume":"18","author":[{"given":"Nai-Wen","family":"Chang","sequence":"first","affiliation":[{"name":"Urology, Chung Shan Medical University Hospital, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Hui","family":"Huang","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taichung City, Taiwan"},{"name":"School of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung-Lang","family":"Chen","sequence":"additional","affiliation":[{"name":"Urology, Chung Shan Medical University Hospital, Taichung, Taiwan"},{"name":"School of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,4,15]]},"reference":[{"key":"2025082707265401000_18.4.e265360.1","unstructured":"National comprehensive cancer network. 2022 Available: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/bladder.pdf"},{"key":"2025082707265401000_18.4.e265360.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2015.05.050"},{"key":"2025082707265401000_18.4.e265360.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctrv.2009.12.005"},{"key":"2025082707265401000_18.4.e265360.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2004.05.003"},{"key":"2025082707265401000_18.4.e265360.5","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1177\/1078155218760160","article-title":"Interstitial pneumonitis and myelosuppression associated to mitomycin C urinary tract instillations: A case report","volume":"25","author":"Rodriguez-Reyes","year":"2019","journal-title":"J Oncol Pharm Pract"},{"key":"2025082707265401000_18.4.e265360.6","doi-asserted-by":"crossref","DOI":"10.1177\/1179547620986158","article-title":"Delayed Bladder Perforation Related to Immediate Single Dose Intravesical Doxorubicin Instillation After TURBT: A Case Report and Literature Review","volume":"14","author":"Alrabadi","year":"2021","journal-title":"Clin Med Insights Case Rep"},{"key":"2025082707265401000_18.4.e265360.7","article-title":"A rare complication of intravesical early instillation of mitomycin C after TURBT","volume":"26","author":"Hatem","year":"2019","journal-title":"Urol Case Rep"},{"key":"2025082707265401000_18.4.e265360.8","doi-asserted-by":"crossref","first-page":"E1","DOI":"10.5489\/cuaj.781","article-title":"Bladder perforation after immediate postoperative intravesical instillation of mitomycin C","volume":"4","author":"Lim","year":"2010","journal-title":"Can Urol Assoc J"},{"key":"2025082707265401000_18.4.e265360.9","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.urolonc.2013.04.006","article-title":"Complications associated with single-dose, perioperative mitomycin-C for patients undergoing bladder tumor resection","volume":"32","author":"Filson","year":"2014","journal-title":"Urol Oncol"},{"key":"2025082707265401000_18.4.e265360.10","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/S0094-0143(21)00419-5","article-title":"Complications of intravesical chemotherapy","volume":"19","author":"Thrasher","year":"1992","journal-title":"Urol Clin North Am"},{"key":"2025082707265401000_18.4.e265360.11","first-page":"5144","article-title":"Pharmacokinetics of intravesical mitomycin C in superficial bladder cancer patients","volume":"51","author":"Dalton","year":"1991","journal-title":"Cancer Res"},{"key":"2025082707265401000_18.4.e265360.12","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1016\/S0210-4806(09)74237-8","article-title":"Pulmonary fibrosis and endovesical mitomycin C","volume":"33","author":"Janeiro Pais","year":"2009","journal-title":"Actas Urol Esp"},{"key":"2025082707265401000_18.4.e265360.13","doi-asserted-by":"publisher","DOI":"10.1378\/chest.128.1.162"},{"key":"2025082707265401000_18.4.e265360.14","doi-asserted-by":"crossref","unstructured":"Ojeda Gomez JSA , Carrillo Bayona JA , Morales Cifuentes LC . 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