Emergency Body CT > Trauma > Bladder


Bladder

Bladder injury occurs in association with blunt pelvic trauma, pelvic fractures or penetrating injuries. Gross hematuria almost always accompanies bladder rupture. Up to 95% of patients with bladder rupture present with gross hematuria. The susceptibility of bladder to injury is dependent on degree of distension, a distended urinary bladder is much more prone to injury than a nearly empty one. Urine extravasation, whether intraperitoneal or extraperitoneal, is dependent on the location of the bladder tear and its relation to the peritoneal reflections. Extraperitoneal rupture is usually the result of shear injury at the base of the bladder. Intraperitoneal rupture often results from a direct blow to a distended bladder. Delayed scans may help display extravasated urine.


Rupture of bladder with extravasation of urine into
the peritoneal cavity (arrow).


Extravasation of the urine/contrast mix into both
the intraperitoneal (arrow) and extraperitoneal
(arrowhead) cavity. Also note the
extensive acetabular fracture (stars).


Visualization of the ruptured bladder can be performed with retrograde cystography or delayed CT after contrast. The effectiveness of each of these approaches is debatable. Retrograde cystography is best reserved for cases in which there is persistent suspicion of bladder injury in spite of a negative CT with a filled bladder or a CT which is suboptimal.

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