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some cases, the urologists may opt to take a patient to the operating room for emergency endoscopy in order to define the obstruction point When all else fails and the patient’s bladder continues to distend, it is safest to pass a suprapubic drainage catheter into the neobladder Because the creation of a neobladder is an intraperitoneal operation, these patients are at risk for developing small bowel obstructions A patient with abdominal pain and a neobladder merits radiographic evaluation Up to 30% of patients with a neobladder develop stones within their pouch and require either endoscopic or open surgical removal These stones rarely cause pain by obstruction, but rather they produce foul urine that can be so irritating to the neobladder that the patient presents with a vague lower abdominal pain These stones are calcified and show up on an abdominal radiograph Treatment with antibiotics is palliative until surgical removal is undertaken The insertion of bowel segments into the urinary tract carries with it certain fluid and electrolyte complications that may not be a problem under normal circumstances However, with GI viral infection and superimposed diarrhea and dehydration, the patient may not be able to compensate For example, a patient with a gastric augmentation who presents with diarrhea and lethargy may have a severe, hypochloremic, hyponatremic, metabolic alkalosis Thus, any patient with a bladder augmented with bowel who is obtunded requires careful consideration of an electrolyte disturbance as the underlying cause Suggested Readings and Key References Approach to the Care of the Technology-Assisted Child Alpern E, Clark A, Alessandrini E, et al Recurrent and high-frequency use of the Emergency Department by pediatric patients Acad Emerg Med 2014;21:365– 373 American Academy of Pediatrics, Committee on Pediatric Emergency Medicine and Council on Clinical Information Technology, American College of Emergency Physicians Pediatric Emergency Medicine Committee Policy statement—emergency information forms and emergency preparedness for children with special health care needs Pediatrics 2010;125(4):829–837 Tracheostomy Care Brook I, Graf J, Stein F Tracheitis in pediatric patients Semin Pediatr Infect Dis 2006;17(1):11–13