Urinary bladder rupture is usually seen in the context of significant trauma.
Bladder rupture be divided into three broad types:
Extraperitoneal bladder rupture
Extraperitoneal rupture is the most common type of bladder injury, accounting for ~85% (range 80-90%) of cases. It is usually the result of pelvic fractures or penetrating trauma. Cystography reveals a variable path of extravasated contrast material. Treatment is with an indwelling catheter (IDC/Foley).
Intraperitoneal bladder rupture
Occurs in approximately ~15% (range 10-20%) of major bladder injuries, and typically is the result of a direct blow to the already distended bladder. Cystography demonstrates intraperitoneal contrast material around bowel loops, between mesenteric folds and in the paracolic gutters. Treatment is surgical repair.
Combined bladder rupture
Simultaneous intraperitoneal and extraperitoneal injury. Cystography usually demonstrates extravasation patterns that are typical for both types of injury.
Bladder rupture is one form of genitourinary tract trauma, along with renal trauma and urethral injuries. Contrast enhanced CT is the imaging technique of choice for bladder injuries in the form of CT cystography. This may be combined with standard CT to evauluate the upper tracts. Standard cystography has a more limited role 3.
- 1. Vaccaro JP, Brody JM. CT cystography in the evaluation of major bladder trauma. Radiographics. 20 (5): 1373-81. Radiographics (full text) - Pubmed citation
- 2. Avery LL, Scheinfeld MH. Imaging of male pelvic trauma. Radiol. Clin. North Am. 2012;50 (6): 1201-17. doi:10.1016/j.rcl.2012.08.010 - Pubmed citation
- 3. Ramchandani P, Buckler PM. Imaging of genitourinary trauma. AJR Am J Roentgenol. 2009;192 (6): 1514-23. AJR Am J Roentgenol (full text) - doi:10.2214/AJR.09.2470 - Pubmed citation