Imaging Pearls ❯ Trauma ❯ Bladder
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- “ Multidetector computed tomography (MDCT) cystography is rapidly becoming the most recommended study for evaluation of the bladder for suspected trauma.”
Bladder trauma: multidetector computed tomography cystography
Ishak C, Kanth N
Emerg Radiol (2011)18:321-327 - Bladder Trauma: Facts
Trauma mechanisms
- Blunt trauma (60-85%)
- Penetrating trauma (15-40%)
- Iatrogenic trauma (5%) - Bladder Trauma: Facts
- GU trauma occurs in 5-10% of all patients with trauma
- Bladder injury occurs in 1.6% of blunt trauma cases
- Bladder rupture occurs in 2-11% of patients with pelvic trauma
- However, 60-90% of patients with bladder rupture have a pelvic fracture - Bladder Trauma: Facts
- 70-80% of cases are extraperitoneal rupture
- 15-20% of cases are intraperitoneal rupture
- 5-10% of cases are combined bladder rupture
- intraperitoneal rupture has higher morbidity and mortality
- Bladder Trauma: Facts
- Usually not isolated injuries but associated with other injuries
- Mortality reported in up to 44% of patients but obviously relates to other injuries as well
- CT cystography is needed and has an accuracy approaching 100% for bladder injury
- 80% of injuries are extraperitoneal and most patients do well as the injury is often self limiting with conservative management
- 20% of injuries are intraperitoneal and require surgical repair to prevent urine peritonitis
- Bladder Trauma: Facts
- 10% of GU system injuries are to the bladder
- Bladder injures occur in 1.6% of blunt abdominal trauma cases
- Bladder rupture occurs in 2-11% of patients with pelvic fractures
- 60-90% of patients with bladder rupture have a pelvic fracture - Bladder Trauma: Etiology
- Blunt trauma (60-85%)
- Penetrating trauma (15-40%)
- Iatrogenic trauma (5%) - Bladder Trauma: 5 Categories
- Contusion
- Intraperitoneal (15-20%)
- Interstitial or bladder wall hematoma
- Extraperitoneal (70-80%)
- Combined (5-10%)
---Lower Urinary Tract Trauma
---Sandler CM et al
---World J Urol 16:69-75 - Intraperitoneal Bladder Rupture: Facts
- 15-20% of cases of rupture
- Delayed diagnosis results in increased mortality due in part to risk of chemical peritonitis
- Patients require surgical management - “ MDCT cystography should be done when pelvic fluid is present, especially when there are fractures or gross hematuria, to define which of the patients has a bladder rupture and to define the type of bladder rupture.”
Bladder trauma: multidetector computed tomography cystography
Ishak C, Kanth N
Emerg Radiol (2011) 18:321-327