Presentation
Abdominal pain after TURP.
Patient Data
About 100 mL of non-ionic contrast media was given via a Foley catheter. There is flame-shaped contrast spillage noted from the right lateral wall of the urinary bladder that appears to fill the pelvis, extend into the right hemiscrotal sac and along the right psoas muscle in the retroperitoneal space.
CT scan shows minimal intraperitoneal contrast around the left-sided small bowel loops with free intraperitoneal air. The majority of contrast is visualized in the right retroperitoneum and reaches the right hemiscrotum, suggesting a combined type of bladder injury (intraperitoneal and extraperitoneal rupture).
Case Discussion
CT cystography/cystogram is the standard study to evaluate suspected bladder rupture, which is classified as extraperitoneal (most common), intraperitoneal or combined type.
The mechanism of intraperitoneal bladder rupture is thought to be through pressure forces on a full bladder causing bursting at the dome into the peritoneum.
During transurethral resection of the prostate (TURP), the urinary bladder was filled with glycine and the surgeon mentioned a popping sensation at the time of the procedure.
Differentiating intraperitoneal versus extraperitoneal rupture is important for management purposes, as extraperitoneal ruptures are managed conservatively with placing a Foley's catheter, while intraperitoneal ruptures require surgical repair which was done for this patient.