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Not so FAST: Intraperitoneal Bladder Rupture

Bladder rupture is a relatively rare condition due to the protection of the bladder in the bony pelvis. The most common cause of bladder rupture is blunt force trauma. Motor vehicle accidents account for most cases; however, iatrogenic injuries associated with surgical or endoscopic procedures have also been described. Spontaneous bladder rupture is associated with a high risk of mortality. Most patients with bladder rupture have gross hematuria and complain of pelvic pain with difficulty voiding. In stable patients, the gold standard for diagnosis is a retrograde cystogram.

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Articles of Interest

A Busted Sac: A Case of Spontaneous Bladder Rupture Secondary to Acute Urinary Retention in a Healthy Middle-Aged Male

It is believed that the cause behind spontaneous bladder rupture involves over-distension combined with a weakness in the bladder wall. Hence, pathologies that predispose patients to over-filling of the bladder in the setting of an already-weakened bladder wall may increase the risk of bladder rupture. Such pathologies may include long-term urinary retention in benign prostatic hyperplasia, urethral stricture, female pelvic organ prolapse, inflammation, and malignancy.

Bladder Trauma: A 7 Year Review

Bladder injuries are one of the most frequent urological injuries in trauma patients. Bladder injuries occur in 1.6% of blunt abdominal trauma cases. A mean of 80% are associated with pelvic fracture and the rest occur from a blow to the lower abdomen with distended bladder.

Case of the Exploding Bladder

Diagnosing a ruptured bladder on the bedside FAST exam in the MTC. The patient was a young female who had sustained minor blunt trauma a week prior and had a negative trauma workup at the outside hospital at that time (including CT of abdomen/pelvis). She now presented with abdominal pain and constipation. In addition to abdominal plain films, an ED FAST exam was obtained which was positive for free fluid in multiple quadrants.

Delayed Iatrogenic Bladder Rupture Diagnosed by POCUS in the Emergency Department

The diagnosis of non-traumatic bladder rupture can be overlooked in patients presenting with a peritonitic abdomen. The typically ordered test for such patients is standard CT, which carries a high false-negative rate for bladder rupture. This case highlights the utility of POCUS in facilitating a rapid diagnosis.

EM@3AM: Bladder Rupture

Performing a RUG to evaluate for urethral injury is NOT a substitute for cystography. CT and Plain Film cystography and almost identical sensitivities and specificities.

Intraperitoneal Bladder Rupture: A Common Consequence of Blunt Abdominal Trauma

Bladder rupture is a rare condition due to the protection of the bladder by the sturdy pelvic bones. Today, bladder injuries remain relatively uncommon, accounting for only up to 10% of abdominal trauma. Although motor vehicle collision is the most common cause of injury, intragenic causes, including surgical and endoscopic procedures, have also been identified. Bladder rupture can be divided into intraperitoneal or extraperitoneal rupture.

Pediatric and Adult Blunt Traumatic Bladder Rupture: A Comparative Review

Although blunt traumatic BR is extremely rare, BR is associated with high injury severity score, prolonged length of stay and associated injuries. Diagnosis and treatment are essentially identical for both population. All patients with gross hematuria (with or without pelvic fracture), microscopic hematuria with anterior pelvic fracture and pelvic fracture with pelvic fluid on CT scan warrant evaluation with cystography. Intraperitoneal BR and combined intraperitoneal and extraperitoneal BR should be repaired operatively. Most extraperitoneal BR may be treated nonoperatively with transurethral catheter.

Spontaneous Bladder Rupture: A Diagnostic and Treatment Dilemma (Case Studes and Literature Review)

Spontaneous bladder rupture (SBR) is uncommonly reported and often presents with non-specific clinical features. Therefore, SBR poses a diagnostic and management dilemma for the treating clinician. Pressure of more than 300 cm H2O is required to rupture a normal bladder. Rupture most commonly occurs because of a direct blow to the distended organ. This trauma often leads to perforation in the dome, the thinnest and least supported part of a distended bladder.

Urine Trouble: Tricky Bladder Mimics

Bladder scans are essential to diagnosis, management, and treatment of emergency medicine patients. FAST and RUSH exams1 have incorporated bladder ultrasound to rapidly assess for free fluid in a hemodynamically unstable patient. For infants presenting with fever, POCUS can be used to assess bladder volume to facilitate timing of catheterization. For patients presenting with low urine output, POCUS can help differentiate low urine volume versus obstructive uropathy. Knowing the relevant landmarks, typical bladder shape, and mimics can help accurately identify pathology.