Presentation
Sudden onset back pain and hematuria following motor vehicle collision.
Patient Data
Intraperitoneal extravasation of contrast, and a clear defect in the dome of the bladder, consistent with intraperitoneal bladder rupture.
Perivesical hematoma with small to moderate volume fluid within the pelvis.
Bilateral pelvic sidewall soft tissue contusions. Left-sided pelvic soft tissue contusion with subcutaneous emphysema and additional calcified density of unknown etiology.
Right pelvic sidewall soft tissue contusion.
Linear facture fragment measuring approximately 7 mm seen posterior to the right iliac wing of unclear donor site.
Case Discussion
Bladder injuries occur in approximately 1.6% of patients with blunt abdominal trauma such as motor vehicle collisions 1. Approximately 60% of bladder injuries are extraperitoneal and 30% are intraperitoneal with a combined injury accounting for the other 10%. Intraperitoneal injuries are typically associated with bladder dome rupture and as such, are treated with formal surgical repair. Extraperitoneal injuries, in contrast, are associated with bladder neck, trigone and anterior bladder wall rupture. Treatment as such, include bladder catherization and observation 2.
Thanks in part to the person below for the case assistance:
Matthew Meece, M.D.
General Surgery
University of Miami Miller School of Medicine/Jackson Memorial Hospital
Miami, Florida
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