IS Case 395: Extraperitoneal bladder rupture

Gunvir Gill, MD


2009 URMC Imaging Sciences
Publication Date: 2010-03-09

History

Patient is a 47-year-old male seen status post motor vehicle collision.

Findings

Cystogram shows an extraperitoneal bladder leak at the left bladder base. There is a fracture of the left pubic ramus.

Discussion

Bladder injuries are seen with lower abdominal trauma and in conjunction with pelvic fractures, often due to a motor vehicle collision. They are classified as a contusion, intraperitoneal rupture, or extraperitoneal rupture. Contusions are partial thickness injuries to the bladder wall without evidence of rupture. Intraperitoneal rupture occurs from a blunt force injury to the lower abdomen in a patient with a full bladder and results in rupture at the bladder dome followed by extravasation of urine into the peritoneal cavity. Extraperitoneal rupture most often occurs in association with a pelvic fracture. The injuring force causes rupture at the anterior or anterolateral wall. Bony fragments from a pelvic fracture impale the bladder causing extraperitoneal rupture. This patient had a fracture of the pubic ramus.

It is crucial to differentiate between intra and extraperitoneal bladder rupture. Operative repair is the rule for most intraperitoneal bladder ruptures. By contrast, the majority of extraperitoneal ruptures can be managed nonoperatively with catheter drainage alone. Exceptions include injuries involving the bladder neck, associated rectal or vaginal injury, and those patients requiring laparotomy for other indications.

References

  1. Lynch TH, Martínez-Piñeiro L, Plas E, et al. EAU guidelines on urological trauma. Eur Urol. 2005 Jan;47(1):1-15. PMID: 15582243
  2. Gomez RG, Ceballos L, Coburn M, et al. Consensus statement on bladder injuries. BJU Int. 2004 Jul;94(1):27-32. PMID: 15217426

1 image