Intraperitoneal urinary bladder rupture

Case contributed by Yaïr Glick
Diagnosis certain

Presentation

Lower abdominal pain, urinary retention. High creatinine.

Patient Data

Age: 35 years
Gender: Male

Small hole in the left aspect of the urinary bladder dome with extravasation of contrast material through it into the peritoneal space.

Incidental epiploic appendages of the distal descending colon seen on the background of contrast material.

Case Discussion

Complained of lower abdominal pain, constipation, and urinary retention. History of alcohol abuse.
A urinary catheter was inserted, with passage of bloody urine that quickly became clear. Blood tests showed markedly elevated creatinine (up to 3.2 mg/dL), raising the suspicion for urinary bladder rupture. On further questioning, the patient admitted to recent lower abdominal trauma.

CT with retrograde injection of diluted contrast material into the urinary bladder showed a puncture in dome of the urinary bladder. The urine that was passing into the peritoneal cavity was being absorbed by the peritoneal membrane and creatinine was thereby being introduced into the blood stream.

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