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Urogenital Imaging

Bladder rupture, intraperitoneal

more commonly seen in the absence of pelvic fractures and usually associated with seatbelt injuries. It results from abrupt compression of a distended bladder by the seatbelt. Rupture then occurs at the weakest portion of the bladder wall, the dome which is in contact with the peritoneal surface. Bladder contents are then exposed to the peritoneal cavity. Intraperitoneal rupture has significantly higher morbidity and mortality then extraperitoneal rupture because of urine-induced peritonitis.

Retrograde cystography is the examination of choice for bladder ruptures. The accuracy of cystography varies from 85100%. Usually an initial film is obtained after approximately 100 cc of contrast has been instilled into the bladder (Fig.1). If no extravasation is present then more contrast is placed into the bladder (300 cc). The post drainage film is also very important in that 10% of ruptures are only detected on post-drainage films. CT is more sensitive than conventional cystogram, and at the same time offers evaluation of associated soft-tissue injuries, and is therefore becoming the procedure of choice. Intraperitoneal bladder rupture is a surgical emergency and requires immediate surgical intervention.

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Fig.1

Cystogram demonstrating intraperitoneal rupture of the bladder.
Bladder rupture, intraperitoneal, Fig.1