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Urinary bladder rupture

A urinary bladder rupture is usually seen in the context of significant trauma.

Classification

Bladder rupture be divided into three broad types:

  1. extra-peritoneal
  2. intra-peritoneal
  3. combined
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.

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.

Combined bladder rupture

Simultaneous intraperitoneal and extraperitoneal injury. Cystography usually demonstrates extravasation patterns that are typical for both types of injury.

Radiographic features

CT

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.

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