Intraperitoneal bladder rupture

Case contributed by Michael P Hartung
Diagnosis certain


Motor vehicle collision.

Patient Data

Gender: Male

Right adrenal hematoma. Right posterior 12th rib fracture. Tiny laceration/hematoma in the spleen with surrounding blood. Right transverse process fractures with muscular hematoma. 

Bilateral pelvic ring, left acetabulum, and left sacral fractures. 

Extraperitoneal pelvic hematoma distorting bladder contours. 

Small amount of ascites. 

Stranding about abdominal aorta and IVC. 

Delayed images show intraperitoneal accumulation of contrast opacified urine. Careful review of the bladder dome (sagittal) indicates large linear area of rupture. 

Case Discussion

Important observations from this case:

  • ascites with pelvic fractures should make you strongly suspicious for intraperitoneal bladder rupture
  • you can carefully review the bladder dome and see the large, linear area of rupture even if delayed images are not obtained. This can be best seen on sagittal images, and is the most common location of injury 
  • delayed images help to confirm free intraperitoneal spillage of contrast opacified urine. However, a false negative study would be possible if the bladder did not contain sufficient volume  

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