RUPTURE BLADDER (BLADDER INJURY)

• Bladder injuries occur mostly from external force to full bladder and often associated with pelvic fracture.
• Classical traid- suprapubic pain & tenderness + difficulty in passing urine + haematuria

ETIOLOGY-

1. Surgical (iatrogenic)

• Pelvic surgery
• Diathermy
• Instrumentations
• Endoscopic trauma

    2. Trauma

• RTA
• Kick or blow on abdomen
• Penetrating injury (gun shot, stab)

TYPES-

1. Intraperitoneal rupture (20%)

• When there is surgical trauma or trauma to distended bladder

Etiology-

• Blow, kick or fall or fully distended bladder

Clinical features-

• Sudden pain in suprapubic region
• Syncope and shock
• MC is rent of dome of bladder
• Seen in males mainly
• Diffuse abdominal pain
• Distension of abdomen (urine leakage)
• Later, peritonitis, rigidity, tenderness and rebound tenderness, dull shifting.

  

    2. Extraperitoneal rupture (80%)

• Trauma due to penetrating or blunt injury with fracture of pubis
• MC- pelvic injury

Clinical feature-

• Diffuse pain and tenderness in lower abdomen due to collection of urine and blood in the extraperitoneal space.
• Swelling in scrotum or labia and abdominal wall
•  extravasation limited to perivesical space
• Strangury and inability to pass urine

  

INVESTIGATIONS-

1. Intraperitoneal

• Plain X-ray abdomen –  ground glass appearance
• Peritoneal tap confirms urine
• Cystogram- extravasation of dye into peritoneal cavity or extraperitoneally shows flame sign or pear sign.
• CT scan of abdomen
• With Foley catheter drainage, an extra peritoneal bladder injury should close spontaneously. Colostomy and  bladder  repair  is  appropriate for intraperitoneal bladder injury. Suprapubic cystostomy may be  required  if  a  Foley catheter cannot be passed safely through an injury in the posterior urethra.

     2. Extraperitoneal

• Plain X-ray shows fracture pelvis
• Cystogram shows leak from the bladder

  

TREATMENT-

1. Intraperitoneal rupture-

• Surgery- TOC (emergency laprotomy)
• Bladder tear sutured in 2 layers using vicryl

    2. Extraperitoneal rupture

• Simple catheter drainage
• Bladder is closed with SPC using Maclecot’s catheter
• Surgical repair is indicated in repeated blockade of catheter due to bleeding, bone fragment, tear extending to the bladder neck

 

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