Presentation
Polytrauma. Traumatic amputation right leg with bladder rupture. Initial damage control laparotomy; bladder perforation repaired but unable to dilate in theater. The abdomen was not closed as a relook was planned. There was no urine output via the urinary catheter.
Patient Data
Non-contrast scan shows a urinary catheter within a collapsed bladder, with small amount of residual contrast from previous studies.
Cystogram:
Following administration of 250 mL 5% Omnipaque via the catheter, there is contrast extravasation outside the bladder. Predominantly, contrast lies extraperitoneally within the cave of Retzius (through the diastased pubic symphysis), extending laterally to the right acetabulum, tracking superiorly and retroperitoneally anterior to the right psoas and quadratus lumborum muscles.
Other findings:
Highly comminuted sacral and pelvic fractures transfixed by bilateral S1 and trans-sacroiliac S2 screws, with resultant streak artefact. Further comminuted fractures of the right superior and inferior pubic rami with extension to the acetabulum. Stable appearance of the mildly displaced fracture involving the anterosuperior corner of the L5 vertebra and right transverse process of L5.
Several dilated fluid-filled small bowel loops measuring up to 4 cm in maximal diameter, located within the anterior central abdomen. Due to their focal location, this may represent a low grade small bowel injury or developing adynamic ileus.
Case Discussion
Isolated extraperitoneal bladder ruptures can be managed conservatively. However, this patient had a planned relook for his other orthopedic and general surgical injuries. The anterior bladder rupture was confirmed and repaired.