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Traumatic Rupture of the Bladder

Traumatic Ruptured Bladder


Presentation

  • RESULTS: Thirty-six patients with extraperitoneal (EPR, 61%) and intraperitoneal (IPR) or combined ruptures (39%) were identified; 81% of them presented pelvic-ring fractures.[archive-ouverte.unige.ch]
  • […] accident injury and presented as distension of abdomen and anuria 24 h after injury.[ijhas.in]
  • This report highlights the diagnostic challenges obstetricians and surgeons may encounter with presentations of acute abdomen in pregnancy. The patient presented with acute abdominal pain, voiding difficulty with pyrexia and features of peritonitis.[jmedtropics.org]
  • In addition to publishing papers presented at the annual meetings of the associated organizations, the journal publishes selected unsolicited manuscripts.[ingentaconnect.com]
  • Case presentation An 18-year-old male presented to the emergency department (ED) with several episodes of vomiting bright red blood and abdominal pain.[criticalultrasoundjournal.springeropen.com]
Pain
  • […] complications During TURB 344 References 347 Complications in Laparoscopic Surgery M Muntener FR Romero LR Kavoussi 349 1743 Postoperative Complications 359 References 361 Acute Postoperative Complications M Seitz B Schlenker Ch Stief 364 1812 Chest Pains[books.google.de]
  • (acute) related to tissue damage and swelling Outcomes Comfort level; Pain control behavior; Pain: Disruptive effects; Pain level Interventions Pain management; Analgesic administration; Positioning; Teaching: Prescribed activity/exercise; Teaching:[medical-dictionary.thefreedictionary.com]
  • The symptoms present with bladder trauma include pain (suprapubic pain/tenderness sometimes described as lower abdominal pain/tenderness) and difficult urinating. Sometimes a person is completely unable to pass urine.[healthhype.com]
  • Patients may have severe abdominal and pelvic pain. Often the patient will also have blood in the urine and urination will be difficult and painful. Dehydration is also possible due to loss of fluids.[livestrong.com]
  • Sign and Symptoms of Bladder Injury Pelvic fracture: Pelvic pain, pelvic instability, shock, gluteal hematoma, abdominal tenderness.[urology-textbook.com]
Sepsis
  • MartinezPineiro 552 Intravenous Uroperitoneogram JA MartinezPineiro 554 Coitus Interruptus JA MartinezPineiro 555 Exploding Bladder J Motsch Ch Schramm 556 Education by Humiliation By Far the Best Way of Learning AR Mundy 557 Vena Caval Injury CA Olsson 558 False Sepsis[books.google.de]
  • Complications of bladder injuries include uroascites (free urine in the peritoneal cavity) due to intraperitoneal rupture, infection (including sepsis ), persistent hematuria, incontinence , bladder instability, and fistula.[merckmanuals.com]
  • Surgical therapy Intraperitoneal bladder rupture Intraperitoneal ruptures can lead to sepsis and carry a higher mortality than extraperitoneal injuries. They tend to be large and most commonly occur at the dome of the bladder.[patient.info]
  • COMPLICATIONS• Urinary extravasation• Sepsis & MODS• Haemorrhage• Pelvic infection• Small-capacity bladder• Urinary incontinence• Obstructive uropathy05-Jul-12 management of bladder injuries 39 40.[slideshare.net]
Physician
  • Symptoms When the bladder is ruptured, MedlinePlus explains, it can cause a number of symptoms that can cause physicians to suspect a diagnosis of a ruptured bladder. Patients may have severe abdominal and pelvic pain.[livestrong.com]
  • Furthermore, the accompanying conditions of the patients may distract the physicians to make a differential diagnosis of acute renal failure.[jtraumainj.org]
  • Genitourinary Injuries CCC — Kidney trauma FOAM and web resources The Trauma Professional’s Blog — AAST Revises Renal Injury Grading The Trauma Professional’s Blog — Evaluation of Hematuria in Blunt Trauma About Dr Chris Nickson An oslerphile emergency physician[lifeinthefastlane.com]
  • The alcohol-intoxicated patient presents diagnostic and therapeutic challenges to the emergency physician (EP) that take on additional urgency given the high mortality of unrecognized bladder rupture.[criticalultrasoundjournal.springeropen.com]
  • In a patient without renal impairment, the physician usually maintains the urine output at 1 mL/kg per hour. Note any blood clots in the urine and report an obstructed urinary drainage system immediately.[medical-dictionary.thefreedictionary.com]
Surgical Procedure
  • Iatrogenic The term iatrogenic means that it was caused by some medical treatment or surgical procedure. Bladder injury may occur due to a number of different iatrogenic causes.[healthhype.com]
  • Injury to the bladder or ureter occurs in about 0.3% of cesarean deliveries and about 1% of gynecologic surgical procedures.[mdedge.com]
Gangrene
  • Treatment of Urinary Fistulae Through a Sacral Scar in a Paraplegic Patient F TrigoRocha 574 Entrapped Foley Catheter After Radical Prostatectomy NL Türkeri 576 Unexpected Inferior Vena Caval Thrombus ED Vaughan Jr 577 The Lord of the Rings Fourniers Gangrene[books.google.de]
Aspiration
  • An 18 French nonweighted nasogastric tube was passed without difficulty, and gastric lavage revealed a small amount of blood clots before running clear aspirates that smelled of alcohol.[criticalultrasoundjournal.springeropen.com]
  • 結石、胆管炎 等 Choledocholithiasis (bile duct stones), Cholangitis 13.3 790,000 237,000 1,580,000 21 消化器内科 Gastroenterology 食道、胃、十二指腸、他腸の炎症(その他良性疾患) Inflammation of stomach, gullet, duodenum 5 240,000 72,000 480,000 22 総合診療科 General Internal Medicine 誤嚥性肺炎 aspiration[hosp.ncgm.go.jp]
Dyspnea
  • […] complications During TURB 344 References 347 Complications in Laparoscopic Surgery M Muntener FR Romero LR Kavoussi 349 1743 Postoperative Complications 359 References 361 Acute Postoperative Complications M Seitz B Schlenker Ch Stief 364 1812 Chest Pains and Dyspnea[books.google.de]
Abdominal Pain
  • Four days prior to her admission, she was seen in accident and emergency with abdominal pain and voiding difficulty which was treated as urinary infection and oral antibiotics commenced.[ispub.com]
  • Bladder Injury: Hematuria, oligouria, lower abdominal pain, peritonitis, increasing retention parameters due to the resorption of urine. Diagnostic Work-Up in Suspected Bladder Injury X-ray of the pelvis, retrograde urethrography and cystography.[urology-textbook.com]
  • These injuries in a child can present as abdominal pain, emesis, constipation, multiple ecchymoses, and abdominal distension.[ijhas.in]
  • "Lower abdominal pain in women after binge drinking". BMJ. 335 (7627): 992–3. doi : 10.1136/bmj.39247.454005.BE. PMC 2072017. PMID 17991983. a b "UOTW #1 - Ultrasound of the Week". Ultrasound of the Week. 19 May 2014.[en.wikipedia.org]
  • EPs should consider this diagnosis in patients presenting with nonspecific worsening abdominal pain in the context of a recent alcohol binge.[criticalultrasoundjournal.springeropen.com]
Suprapubic Pain
  • The symptoms present with bladder trauma include pain (suprapubic pain/tenderness sometimes described as lower abdominal pain/tenderness) and difficult urinating. Sometimes a person is completely unable to pass urine.[healthhype.com]
  • Suprapubic pain or tenderness. Most patients with bladder rupture complain of suprapubic or abdominal pain. Difficulty or inability to void. Many can still void but the ability to urinate does not exclude bladder injury or perforation.[patient.info]
  • CLINICAL FEATURES relatively nonspecific• Triad of symptoms is often present (1) gross haematuria (90%), (2) suprapubic pain or tenderness, (3) difficulty or inability to void. 05-Jul-12 management of bladder injuries 27 28.[slideshare.net]
  • The patient needs to be monitored for complications throughout the hospital stay, such as infection (dysuria, low back pain, suprapubic pain, and foul or cloudy urine), impaired wound healing (seepage of urine from repair sites, flank or abdominal mass[medical-dictionary.thefreedictionary.com]
Acute Abdomen
  • 344 References 347 Complications in Laparoscopic Surgery M Muntener FR Romero LR Kavoussi 349 1743 Postoperative Complications 359 References 361 Acute Postoperative Complications M Seitz B Schlenker Ch Stief 364 1812 Chest Pains and Dyspnea 373 1813 Acute[books.google.de]
  • J Med Trop 2015;17:107-9 Introduction Rupture of the urinary bladder in pregnancy usually presents as acute abdomen but with its own peculiar diagnostic challenges.[jmedtropics.org]
  • abdomen with haematuria after a spell of protracted vomiting.[casereports.bmj.com]
  • The patient later presented with symptoms of acute abdomen due to urine peritonitis and biochemical features of kidney impairment (creatinine was 362umol/L).Urine leak into peritoneal cavity led to shrinkage of the bladder and possible disimpaction of[ispub.com]
Acute Abdomen
  • 344 References 347 Complications in Laparoscopic Surgery M Muntener FR Romero LR Kavoussi 349 1743 Postoperative Complications 359 References 361 Acute Postoperative Complications M Seitz B Schlenker Ch Stief 364 1812 Chest Pains and Dyspnea 373 1813 Acute[books.google.de]
  • J Med Trop 2015;17:107-9 Introduction Rupture of the urinary bladder in pregnancy usually presents as acute abdomen but with its own peculiar diagnostic challenges.[jmedtropics.org]
  • abdomen with haematuria after a spell of protracted vomiting.[casereports.bmj.com]
  • The patient later presented with symptoms of acute abdomen due to urine peritonitis and biochemical features of kidney impairment (creatinine was 362umol/L).Urine leak into peritoneal cavity led to shrinkage of the bladder and possible disimpaction of[ispub.com]
Chest Pain
  • Pains and Dyspnea 373 1813 Acute Abdomen 377 1814 Postoperative Fever 378 1815 Abdominal Wound Dehiscence 403 1816 Chylous Ascites 410 1817 Deep Venous Thrombosis 414 1818 Lymphoceles 416 References 421 Preventing and Managing Infectious Emergencies[books.google.de]
Thrombosis
  • 359 References 361 Acute Postoperative Complications M Seitz B Schlenker Ch Stief 364 1812 Chest Pains and Dyspnea 373 1813 Acute Abdomen 377 1814 Postoperative Fever 378 1815 Abdominal Wound Dehiscence 403 1816 Chylous Ascites 410 1817 Deep Venous Thrombosis[books.google.de]
Fracture
  • Orthopaedists increasingly use open reductions and fixation of pelvic-ring fractures, prompting urologists to suture EPRs simultaneously.[archive-ouverte.unige.ch]
  • Mundy 557 Vena Caval Injury CA Olsson 558 False Sepsis and Advanced TCC CA Olsson 559 Laparoscopic Vascular Emergency V Pansadoro 560 Percutaneous Nephrolithotomy E PerezCastro E 561 Bladder Tumor E PerezCastro E 562 Frenulum E PerezCastro E 563 Penile Fracture[books.google.de]
  • High velocity MVA ---Open pelvic fractures 3. Open pelvic trauma 4. Open pelvic fractures --Communication between fracture fragments and skin or a pelvic visceral cavity. • 4-5% of pelvic fractures • Mortality is 30%--50% in open fractures 5.[de.slideshare.net]
  • Open pelvic fractures. Risk factors and mechanism of urethral injury in pelvic fractures. Trauma to the Adult Pelvis and Hip. Management of Pelvic Fractures with Concomitant Urologic Injuries.[wheelessonline.com]
  • Bladder injury is often associated with other traumatic injuries, most commonly pelvic fracture.[unboundmedicine.com]
Hematuria
  • […] injury (including non-urinary tract structures) About 5% of renal injuries and up to 20% of renovascular injuries lack hematuria — even severe injuries such as renal artery injury or ureteropelvic disruption may present without hematuria GOALS find source[lifeinthefastlane.com]
  • Microscopic hematuria has to be detected with laboratory tests but in gross hematuria the presence of blood in the urine is visible to the naked eyes.[healthhype.com]
  • It is self-limiting and requires no specific therapy, except for rest until hematuria resolves. Nevertheless, it should remain a diagnosis of exclusion. Persistent hematuria or unexplained lower abdominal pain requires further investigation.[emedicine.medscape.com]
  • Relative indications: Gross hematuria without pelvic fracture, microhematuria with pelvic fracture, isolated microscopic hematuria (10) Alert During plain film cystography, a post-void view is mandatory as contrast in the bladder may mask extravasation[tipsdiscover.com]
  • They generally present with gross hematuria upon placement of the bladder catheter. This should prompt an abdominal CT scan with cystogram technique. CT cystogram involves pressurizing the bladder with contrast prior to the study.[regionstraumapro.com]
Urinary Incontinence
  • Patients may or may not have residual problems with urinary incontinence or sexual functioning. Loss of urinary continence leads to self-esteem and body image disturbances.[medical-dictionary.thefreedictionary.com]
  • COMPLICATIONS• Urinary extravasation• Sepsis & MODS• Haemorrhage• Pelvic infection• Small-capacity bladder• Urinary incontinence• Obstructive uropathy05-Jul-12 management of bladder injuries 39 40.[slideshare.net]
Pelvic Pain
  • Patients may have severe abdominal and pelvic pain. Often the patient will also have blood in the urine and urination will be difficult and painful. Dehydration is also possible due to loss of fluids.[livestrong.com]
  • Sign and Symptoms of Bladder Injury Pelvic fracture: Pelvic pain, pelvic instability, shock, gluteal hematoma, abdominal tenderness.[urology-textbook.com]
Dysuria
  • The patient needs to be monitored for complications throughout the hospital stay, such as infection (dysuria, low back pain, suprapubic pain, and foul or cloudy urine), impaired wound healing (seepage of urine from repair sites, flank or abdominal mass[medical-dictionary.thefreedictionary.com]

Workup

  • […] bladder before, during, and after injection; oblique views are usually most informative; extravasation indicating urethral injury is generally readily apparent After posterior urethral injury is excluded and a catheter has been inserted, the radiographic workup[emedicine.medscape.com]

Treatment

  • Laparoscopic suture is an advantageous treatment of isolated IPR.[archive-ouverte.unige.ch]
  • Priapism WO Brant AJ Bella MM Gracia TF Lue 301 162 Classification 302 164 Evaluation 303 165 Management 304 166 Surgical Treatment of Ischemic Priapism 305 167 Postoperative Care 308 169 Recurrent Stuttering Priapism 309 1610 Mechanical Priapism 310[books.google.de]
  • Treatment of Bladder Injury Conservative Treatment: Small extraperitoneal bladder injuries can be treated by inserting a transurethral catheter only.[urology-textbook.com]
  • Treatment is surgical repair. Extraperitoneal rupture is the most common type of bladder injury, accounting for 85% (range 80-90%) of cases. It is usually the result of pelvic fractures or penetrating trauma.[radiopaedia.org]
  • Treatment of Bladder Trauma The treatment for bladder trauma largely depends on the severity of the condition, type of injury and to some extent on the cause of the trauma.[healthhype.com]

Prognosis

  • […] anterolaterally extraluminal contrast into perivesical space (simple) molar tooth sign extension of extraluminal contrast to the thigh, scrotum or perineum (complex) combined mixed features of intraperitoneal and extraperitoneal rupture Treatment and prognosis[radiopaedia.org]
  • PROGNOSIS Appropriate Rx Excellent outcome Bladder neck involvement Temporary incontinence05-Jul-12 management of bladder injuries 47 48.[slideshare.net]
  • Erectile dysfunction occurs in 20-60% of patients after traumatic urethral rupture. [ 9 ] Prognosis Traumatic bladder ruptures were once uniformly fatal. They are currently usually managed successfully.[patient.info]
  • Delayed bladder injury presentation is possible and high index of suspicion is needed for timely treatment and better prognosis. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. References 1.[ijhas.in]

Etiology

  • Etiology Bladder rupture can be categorized into five types depending on the location and extent of the rupture: Bladder contusion This is commonly seen but sometimes not classed as true rupture, since it involves an incomplete tear of the mucosa.[radiopaedia.org]
  • Etiology (Causes) of Bladder Injury Pelvic Fracture: Injury of the bladder due to a pelvic fracture is caused by perforation of the bladder by sharp fracture fragments. The location of the bladder injury is usually extraperitoneal.[urology-textbook.com]
  • Etiology and Pathophysiology Bladder contusion ( 1 )[ C ] Damage to bladder mucosa or muscularis without full thickness injury, usually presenting with gross hematuria but no extravasation on cystogram Blunt bladder trauma is associated with rapid deceleration[unboundmedicine.com]
  • It is defined as rupture of the urinary bladder into the peritoneal cavity or pelvic cellular tissue without a history of trauma, rupture is more often intraperitoneal as in the presented case than extraperitoneal. [1] Etiological factors that have been[jmedtropics.org]
  • Pediatric Considerations Children Etiology The cause of injury is usually high-energy trauma (motor vehicle accidents, falls).[tipsdiscover.com]

Epidemiology

  • Definition and Epidemiology of Bladder Injury Injuries of the urinary bladder are caused by blunt or penetrating trauma. A less common pattern of injury is surgery of the pelvis or transurethral operations.[urology-textbook.com]
  • Epidemiology Incidence 1.6% of blunt abdominal trauma cases have an associated bladder injury ( 1 )[ C ]. 80% of bladder injuries are associated with pelvic fracture. 10% of pelvic fractures are associated with bladder injury. 90% of bladder injuries[unboundmedicine.com]
  • Classified as either intraperitoneal or extraperitoneal rupture Bladder contusion is injury to the mucosa or muscularis without full-thickness loss; without urine extravasation Often associated with ureter/urethral injury and/or other non-urological injuries Epidemiology[tipsdiscover.com]
Sex distribution
Age distribution

Pathophysiology

  • Etiology and Pathophysiology Bladder contusion ( 1 )[ C ] Damage to bladder mucosa or muscularis without full thickness injury, usually presenting with gross hematuria but no extravasation on cystogram Blunt bladder trauma is associated with rapid deceleration[unboundmedicine.com]
  • Risk Factors High-energy mechanism (fall, motor vehicle accident [MVA]) Pelvic fracture Penetrating wound Prior bladder/pelvic surgery Pelvic radiotherapy General Prevention Seat belts: Voiding prior to automobile travel Pathophysiology Bladder is often[tipsdiscover.com]

Prevention

  • Complications M Seitz B Schlenker Ch Stief 364 1812 Chest Pains and Dyspnea 373 1813 Acute Abdomen 377 1814 Postoperative Fever 378 1815 Abdominal Wound Dehiscence 403 1816 Chylous Ascites 410 1817 Deep Venous Thrombosis 414 1818 Lymphoceles 416 References 421 Preventing[books.google.de]
  • This will prevent urine from building up in the bladder. It will also allow the injured bladder or urethra to heal and prevent swelling in the urethra from blocking urine flow.[medlineplus.gov]
  • •Intraperitoneal bladder rupture: exploration and suture closure or If a supra-pubic catheter is used, it should be tunnelled to prevent anterior wound contamination 23.[de.slideshare.net]
  • Antibiotics are often given to prevent infections from developing. In some cases patients may have an overactive bladder for a few months, which is a result of inflammation of the bladder lining.[livestrong.com]
  • This can help prevent severe urethral stricture formation. Alternatively, primary urethral realignment may be attempted at bedside via flexible cystoscopy and guidewire placement.[emedicine.medscape.com]

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