Presentation
Abdominal pain, not passing urine or stool, and vomiting. History of blunt trauma.
Patient Data
Non-contrast scans show extensive abdominal ascites of unknown origin. Ascending cystography evaluation confirms a defect on the bladder dome with subsequent contrast leakage into the peritoneal cavity. The rest of the bladder wall is intact. Normal ureteric pathways were noted.
Case Discussion
CT cystography is more effective than retrograde cystography because it is less invasive and provides more information. The weakest site on the urinary bladder is the dome and a sudden increase in intravesical pressure due to blunt trauma frequently results in intraperitoneal urinary bladder perforation.
The most typical CT image finding of intraperitoneal bladder perforation is the accumulation of ascetic fluid. CT is more expensive and confers greater radiation, however, CT takes less time and includes more detail of the surrounding pelvic structures.
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