Intraperitoneal urinary bladder rupture

Case contributed by Dr Michal Klán

Presentation

At a party 5 days ago, patient was pushed into a shallow swimming pool, falling on her lower back. Then she started to feel the pain in a lower abdomen, later even vomiting and diarrhea had occurred. After 4 days, patient had been admitted to a hospital for the gastroenteritis treatment (rehydratation because of oliguria). Next day her condition was even worse, with renal failure (serum creatinine level was 1212 μmol/l).

Patient Data

Age: 19
Gender: Female

Non-contrast CT shows massive amount of intraperitoneal free fluid. Measured densities of the fluid are about 5-15 HU.

Notice the gap in the dome of the urinary bladder. No evidence of any other injuries.

Fluoroscopy

Retrograde cystography

Frontal x-ray in the upright position, after the contrast medium was administrated into the bladder (retrograde cystography).

 Pronounced leak into the peritoneal cavity is evident.

Case Discussion

Intraperitoneal urinary bladder rupture is an uncommon condition, which is sometimes not so easy to diagnose.

Attention should be paid if there was a lower abdominal injury and ascites is found.

Full bladders are far more susceptible to rupture than is an empty one.

Surgical treatment is usually needed, like it was in this case - there was a wide gap in the bladder apex (approximately 4 cm), which had been closed.

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Case information

rID: 38215
Case created: 10th Jul 2015
Last edited: 20th Jun 2017
System: Urogenital
Inclusion in quiz mode: Included

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