CASE 758 Published on 15.05.2001

Combined intraperitoneal and extraperitoneal bladder rupture

Section

Uroradiology & genital male imaging

Case Type

Clinical Cases

Authors

WK Lee, CJ Roche, VA Duddalwar

Patient

33 years, male

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Clinical History

33 year old male involved in a motor car accident and brought to hospital unconscious. Physical examination demonstrated blood per urethra.

Imaging Findings

Patient involved in a motor car accident and brought to hospital unconscious. Physical examination demonstrated blood per urethra. Focussed abdominal ultrasound for trauma demonstrated moderate pelvic free fluid. Following insertion of a suprapubic catheter into the bladder, a retrograde urethrogram was performed to further assess integrity of the urethra and bladder.

Discussion

Bladder rupture is due to blunt, penetrating or iatrogenic injury, and can be classified as intraperitoneal or extraperitoneal. Intraperitoneal bladder rupture accounts for 20% of all bladder ruptures. It occurs at the dome of the bladder especially with a distended bladder. There is sudden rise in intravesical pressure usually as a result of blunt abdominal trauma. Individuals in motor car accidents, especially those wearing a lap type seat belt, are especially prone to this type of injury. 25% of individuals with this type of bladder injury do not have associated pelvic fractures. Cystogram or delayed contrast enhanced CT will demonstrate intraperitoneal contrast extravasation, especially into the paracolic gutters, and outlining of small bowel loops. This usually requires emergent surgical repair. Extraperitoneal bladder rupture accounts for 80% of all bladder ruptures. It usually occurs close to the bladder base or the anterolateral wall. It is usually due to laceration from an adjacent bony spicule from a fracture of the anterior pelvic arch. Cystogram or delayed contrast enhanced CT will demonstrate perivesical contrast extravasation which may extend into the retroperitoneum, perineum, scrotum, thigh or anterior abdominal wall. Most extraperitoneal bladder ruptures will close spontaneously, and hence, will be managed conservatively.

Differential Diagnosis List

Combined intraperitoneal and extraperitoneal rupture of bladder.

Final Diagnosis

Combined intraperitoneal and extraperitoneal rupture of bladder.

References

[1] Davidson AJ, Hartman DS, Choyke PL, Wagner BJ
Radiologic evaluation of urinary tract trauma.
In Radiology of the kidney and genitourinary tract.
WB Saunders, Philadelphia, pp 712 (1999).

[2] Dahnert W
Urogenital tract.
In Radiology review manual.
Williams and Wilkins, Baltimore, pp 763 (1999).

[3] Sandler CM, Phillips JM, Harris JD, Toombs BD
Radiology of the bladder and urethra in blunt pelvic trauma.
Radiol Clin North Am 1981 Mar; 19(1):195-211. (PMID: 7012911)

Case information

URL:	https://eurorad.org/case/758
DOI:	10.1594/EURORAD/CASE.758
ISSN:	1563-4086

Figure 1

Bladder rupture

Retrograde urethrogram demonstrates contrast extravasation from the bladder which outlines small bowel loops and pools predominantly in the right iliac fossa. In addition, there is a large amount of perivesical contrast which is tracking into the right scrotum and thigh. Note fracture of left inferior pubic ramus.