Presentation
Alleged assault while intoxicated. CT imaging followed.
Patient Data
There is free fluid in the abdomen and pelvis. Subtle stranding is demonstrated surrounding the bladder, which is difficult to appreciate with the adjacent free fluid.
A CT cystogram has been performed after approximately 400ml of urograffin contrast has been administered via a urinary catheter. A large volume of contrast is demonstrated in the abdominal cavity consistent with an intraperitoneal urinary bladder rupture.
Case Discussion
Bladder rupture is uncommon. It typically follows significant trauma to the pelvis, for example following a RTA, assualt or a fall from a height. It is often associated with other injuries, in particular pelvic fractures.
High clinical suspicion combined with suggestive findings on a standard trauma CT (portal venous phase) is required, to instigate the decision to instill iodinated contrast via a urinary catheter to clinch the diagnosis.