A 76 yo female presents after a fall down several stairs. She is diagnosed with bilateral pubic rami fractures on x-ray. The patient has difficulty with urination. A foley is placed and there is blood return. A CT cystogram is shown below. What’s the diagnosis?
Answer: Bladder injury (extraperitoneal)
- Occurs with direct blunt trauma to distended bladder
- 70-97% associated with pelvic fractures
- Clinically, patient will have gross hematuria, lower abdominal tenderness, perineal or scrotal edema, difficulty voiding
- Gold standard diagnosis: retrograde cystogram (either x-ray or CT)
- Can be missed on routine CT or US
- Intraperitoneal rupture: contrast material leaks into peritoneal cavity
- Require surgical repair
- Extraperitoneal rupture: contrast material leaks into retroperitoneum
- Most common
- Usually managed conservatively and heal within 2 weeks
References:
Gratton MC, French L. Genitourinary Trauma. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds.Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8eNew York, NY: McGraw-Hill; 2016.
