Intraperitoneal rupture of bladder
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 I: Bladder contusion
- 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
- VCUG
- Diagnostic evaluation of bladder rupture includes voiding cystourethrography (VCUG) or CT scan
- US
- \"Bladder within a bladder\" = bladder surrounded by fluid collection