Presentation
Pelvic trauma post fall from 8m. Initial trauma CT shows S1 fracture through the left sacral ala involving the left L5-S1 facet joint and left sacroiliac joint inferiorly with diastasis of the pubic symphysis. Fluid in pelvis and scrotum ? bladder rupture
Patient Data
Water soluble contrast agent injected via the indwelling catheter.
Diastasis of the pubic symphysis and sacral fractures are again demonstrated. There is extravasation of contrast to the left anteroinferior aspect of the bladder, with contrast tracking through the pubic diastasis into the scrotum and along the left pelvic sidewall into the medial compartment of the left thigh. Small amount of contrast is also extravasated into the lower aspect of the rectus sheath. Intrinsic linear high density along the medial aspect of the left rectus abdominis is noted.
No intraperitoneal contrast extravasation. Extraperitoneal hematoma is also demonstrated in the presacral region.
Conclusion
Extraperitoneal bladder rupture with contrast extravasating into the lower rectus sheath, scrotum and left thigh.
Case Discussion
Bladder rupture can be intraperitoneal (treated with surgery) or extraperitoneal (treated with IDC) or both.