Bladder rupture

Type I: Bladder contusion most common form. Results from an incomplete tear of bladder mucosa. Cystography is normal.

Type II: Intraperitoneal rupture. Results from a trauma (blow) to the lower abdomen when the bladder is distended. Because the bladder dome is the 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. Subdivided into: simple, with extravasation limited to perivesical space; and complex, with extravasation extending to thigh, scrotum or perineum.

Type V: Combined extra- and intraperitoneal rupture.

Extraperitoneal bladder rupture is the most common type, occurring in 80% of bladder rupture cases. Extraperitoneal bladder rupture is generally the result of secondary to adjacent pelvic fracture or an avulsion tear at fixation points of puboprostatic ligaments. It usually occurs close to the bladder base anterolaterally. Intraperitoneal bladder rupture is usually iatrogenic or secondary to penetrating injury. Blunt trauma is more likely to result in intraperitoneal rupture in children than in adults because the paediatric bladder is more intraperitoneal in location. The adult bladder dome remains mostly extraperitoneal, and blunt trauma in an adult can result in intraperitoneal rupture only if the bladder is fully distended. While extraperitoneal bladder can be treated conservatively, intraperitoneal bladder rupture requires surgical repair. The highest morbidity and rupture mortality is associated with intraperitoneal rupture because of the potential for development of chemical peritonitis.

Diagnostic evaluation of bladder rupture includes voiding cystourethrography (VCUG) or CT scan (Fig.1). Voiding cystourethrography has historically been the preferred contrast enhanced study for the diagnosis of bladder rupture. The bladder needs to be fully distended and evaluation of a postvoiding film is essential. Recently, the use of a CT cystogram has been advocated as more sensitive in the detection of small bladder rupture, having superb ability to differentiate between intra- and extraperitoneal bladder rupture and to simultaneously evaluate any other bony or soft tissue injury. Also, see bladder rupture extraperitoneal and bladder rupture intraperitoneal.

HH