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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

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