Bladder Rupture

 

• Can be secondary to traumatic or iatrogenic injury
• Five types of rupture
  • Type I: Bladder contusion
    • Most common form
    • Results from incomplete tear of bladder mucosa
    • Cystography is normal
       
• Type II: Intraperitoneal rupture
  • Results from trauma to lower abdomen when bladder is distended
  • Because bladder dome is weakest portion, it ruptures most easily
  • Contrast is then seen in the paracolic gutters and between loops of small bowel
     
• Type III: Interstitial injury-rare
  • Caused by a tear of the serosal surface
  • Mural defect without extravasation will be seen
     
• Type IV: Extraperitoneal
  • Almost always associated with pelvic fractures
  • Usually close to base of bladder anterolaterally
  • Subdivided into
    • Simple, with extravasation limited to perivesical space
    • Complex, with extravasation extending to thigh, scrotum or perineum
       
• Type V: Combined extra- and intraperitoneal rupture
   
• Extraperitoneal bladder rupture is the most common type
  • Occurs in 80% of bladder rupture cases
  • Extraperitoneal bladder rupture generally secondary to adjacent pelvic fracture or an avulsion tear at fixation points of puboprostatic ligaments
• Intraperitoneal bladder rupture
  • Usually iatrogenic or secondary to penetrating injury
  • Blunt trauma more likely to result in intraperitoneal rupture in children than in adults
    • Because the pediatric bladder is more intraperitoneal in location.
    • The adult bladder dome remains mostly extraperitoneal
      • Blunt trauma in an adult can result in intraperitoneal rupture only if the bladder is fully distended
  • Imaging findings
    • Contrast extravasation into paracolic gutters
    •  Contrast outlining small bowel loops
• While extraperitoneal bladder rupture can be treated conservatively, intraperitoneal bladder rupture requires surgical repair
• Highest morbidity and rupture mortality is associated with intraperitoneal rupture because of potential for development of chemical peritonitis
• Imaging findings
  • Diagnostic evaluation of bladder rupture includes voiding cystourethrography (VCUG) or CT scan
    • VCUG
      • Voiding cystourethrography historically been preferred contrast enhanced study for diagnosis of bladder rupture
      • Bladder needs to be fully distended and evaluation of a post-voiding film essential
    • Plain film:
      • "Pear-shaped" bladder
      • Paralytic ileus
      • Upward displacement of ileal loops
      • Flame-shaped contrast extravasation into perivesical fat
        • Best seen on postvoid films
        • May extend into thigh / anterior abdominal wall

      
      
      One image from an IVU shows a flame-shaped density adjacent to
      right lateral wall of bladder representing extra-peritoneal contrast from a bladder rupture
       

      • US
        • "Bladder within a bladder" = bladder surrounded by fluid collection

Amersham Health Encyclopedia