Bladder trauma: multidetector computed tomography cystography

Combined intra- and extraperitoneal urinary bladder rupture - a rare seat-belt injury: A case report

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Combined intra- and extraperitoneal traumatic urinary bladder ruptures without an underlying fracture are an absolute rarity.

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Timely diagnosis and appropriate therapy of urinary bladder ruptures are crucial in order to reduce postoperative morbidity.

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Physicians should maintain a high level of suspicion for urologic injuries following blunt abdominal trauma in the presence of nonspecific lower abdominal pain, gross haematuria and the inability to urinate.

Introduction

While isolated traumatic urinary bladder injuries are rare, combined intra- and extraperitoneal traumatic urinary bladder ruptures without an underlying fracture are an absolute rarity.

Presentation of case

We report a case of combined intra- and extraperitoneal urinary bladder rupture without an underlying fracture resulting from blunt abdominal trauma during a high velocity car accident. A midline laparotomy was performed, and the intra- and extraperitoneal bladder ruptures were surgically treated.

Discussion

Based on the presented case the anatomical peculiarities of the urinary bladder and the different trauma mechanisms as well as the resulting lesions, the diagnostic modalities and the treatment options are discussed.

Conclusion

Despite the rarity of traumatic urinary bladder injuries, and especially in the absence of an underlying fracture, physicians should maintain a high level of suspicion for urologic injuries in the presence of nonspecific lower abdominal pain, gross haematuria and the inability to urinate.

BWH emergency radiology-surgical correlation: intraperitoneal urinary bladder rupture

We describe the radiological and intraoperative correlation of two cases of intraperitoneal bladder rupture: a 23-year-old man involved in a high-speed motor vehicle collision and a 49-year-old man with hematuria and abdominal pain after a night of heavy alcohol ingestion. Both patients underwent urgent exploratory laparotomies and repair of their bladder injuries. The purpose of this article is to emphasize the importance of understanding the different etiologies of bladder rupture and recognizing the imaging findings on computed tomography (CT) and CT cystography to help guide the surgeons in the patient's management.

Complications of minimally invasive procedures of the abdomen and pelvis: a comprehensive update on the clinical and imaging features

Minimally invasive gastrointestinal, genitourinary, and gynecological procedures are widely used in the clinical practice for diagnostic and therapeutic purposes. Complications both minor and major are not uncommon with these procedures. Imaging plays an important role in the detection and optimal management of these complications. Familiarity with the clinical and imaging features of these complications by radiologists can help in their timely detection.

Multidetector CT cystography for imaging colovesical fistulas and iatrogenic bladder leaks

Multidetector computed tomography (MDCT) cystography currently represents the modality of choice to image the urinary bladder in traumatized patients. In this review we present our experience with MDCT cystography applications outside the trauma setting, particularly for diagnosing bladder fistulas and leaks. A detailed explanation is provided concerning exam preparation, acquisition technique, image reconstruction and interpretation. Colovesical fistulas most commonly occur as a complication of sigmoid diverticular disease, and often remain occult after extensive diagnostic work-up including cystoscopy and contrast-enhanced CT. We consistently achieved accurate preoperative visualization of colovesical fistulas using MDCT cystography. Urinary leaks and injuries represent a non-negligible occurrence after pelvic surgery, particularly obstetric and gynaecological procedures: in our experience MDCT cystography is useful to investigate iatrogenic bladder leaks or fistulas. In our opinion, MDCT cystography should be recommended as the first line modality for direct visualization or otherwise confident exclusion of both spontaneous enterovesical fistulas and bladder injuries following instrumentation procedures, obstetric or surgical interventions.

Main Messages

• Explanation of exam preparation, acquisition technique, image reconstruction and interpretation.

• Preoperative visualization of colovesical fistulas, usually secondary to sigmoid diverticulitis.

• Visualization or exclusion of iatrogenic bladder injuries following instrumentation or surgery.