Traumatic urethra and bladder rupture

Case contributed by RMH Core Conditions

Presentation

Driver in MVA. Blood at external urethral meatus.

Patient Data

Age: 20 years old
Gender: Male
Fluoroscopy

Retrograde urethrogram

Contained extravasation of the contrast at the level of the membranous urethra is consistent with traumatic injury. Contrast drainage into the bladder indicates partial preservation of the luminal continuity.

CT

Pelvis

On the non-contrast study, there is a small amount of extravasated contrast (from prior urethrogram) within the retro-pubic space (cave of Retzius), inferior extraperitoneal pelvic cavity and tracking into the perineum/perineal muscles and adductor musculature of the left thigh. This is consistent with the known urethral rupture seen on the prior urethrogram.

Post-stress cystogram, there is further contrast extravasation into the right extraperitoneal space. No intraperitoneal contrast extravasation to suggest intraperitoneal bladder rupture.

A moderate volume of extraperitoneal pelvic haematoma is demonstrated, partially mixed with the extravasated contrast and presumably urine. There is further pooling of the extravasated contrast on the intravenous-contrast enhanced study, particularly posterosuperiorly anterior to and within the right SI joint.

Small volume retroperitoneal haematoma posterior to the left psoas and anterior to the left iliacus muscle.

A comminuted, minimally displaced fracture of the left sacral body and sacral ala is present, with intra-articular extension into the left SI joint and involvement of the left S1 and S2 nerve root foraminae. 11 mm fracture fragment displaced into the left posterior pelvis anterior to the left sacral ala. There is mild widening/diastasis of the right SI joint (upto 7 mm). There is associated diastasis of the pubic symphysis with the left pubic bone superior to the right. Possible subtle left pubis fracture. Left laterally displaced L5 transverse process fracture.

Left superoposterior and lateral gluteal and suprapubic subcutaneous contusions noted.

Case Discussion

In summary, injuries sustained:

  • traumatic urethral rupture at the level of the membranous urethra
  • bladder rupture (proven at OT)
  • bony pelvis fractures and pelvic haematoma
  • pubic bone and sacro-iliac joint diastasis
  • L5 transverse process fracture
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Case information

rID: 27759
Case created: 18th Feb 2014
Last edited: 1st Oct 2016
System: Urogenital
Inclusion in quiz mode: Included

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