Bladder rupture (intraperitoneal)
History of high grade urothelial carcinoma, invasive into surrounding musculature and prostatic urethra. CT of the abdomen and pelvis four days earlier showed an intraperitoneal collection adjacent to the bladder dome.
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150 ml of Isovue 300 was infused through the patient's indwelling Foley catheter.
The bladder partially distended and the bladder wall appeared irregular. There was resistance to hand injection of contrast, likely due to chronic blood products adherent to the catheter. With a small adjustment, contrast then began to flow freely into the bladder and began to leak into the intraperitoneal space, outlining bowel loops.
Intraperitoneal bladder rupture can be differentiated from extraperitoneal bladder rupture, if contrast outlines loops of bowel. Oblique images may also be helpful in differentiating the two, although localization using the normal positions of pelvic structures could be misleading in a postoperative pelvis.