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Traumatic Urinary Bladder Rupture

Traumatic Bladder Rupture


Presentation

  • 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]
  • In addition to publishing papers presented at the annual meetings of the associated organizations, the journal publishes selected unsolicited manuscripts.[ingentaconnect.com]
  • In this case the correct diagnosis was made by CT, and a repeat cystogram confirmed that no bladder injury was present.[springerlink.com]
  • February 04, 2010 Number of Print Pages: 3 Number of Figures: 0 Number of Tables: 0 ISSN: 0042-1138 (Print) eISSN: 1423-0399 (Online) For additional information: Abstract A case of laparoscopic management of intraperitoneal traumatic bladder rupture is presented[karger.com]
  • 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]
Gastric Lavage
  • 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]
Abdominal Pain
  • EPs should consider this diagnosis in patients presenting with nonspecific worsening abdominal pain in the context of a recent alcohol binge.[criticalultrasoundjournal.springeropen.com]
  • 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]
  • Case Report A 20-year-old patient presented with distended abdomen, oliguria and vague abdominal pain for 6 days following normal vaginal delivery in a primary health center.[jfmpc.com]
  • These injuries in a child can present as abdominal pain, emesis, constipation, multiple ecchymoses, and abdominal distension.[ijhas.in]
  • 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]
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]
  • 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]
  • 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]
  • 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]
  • A provisional diagnosis of acute abdomen due to bowel injury was kept and he was catheterised to monitor his urine output. After per urethral catheterisation it drained 4.5 litres of blood stained urine and the distension of abdomen disappeared.[omicsonline.org]
Scleral Icterus
Abnormal Behavior
Hematuria
  • A 70 years-old man was admitted for acute peritonitis, acute urinary retention and hematuria. Laparotomy and exploration showed acute generalized peritonitis related to a centimeter hole in the bladder dome.[ajol.info]
  • Conclusions: Disproportionate acidosis in the trauma patient is a sensitive indicator of bladder injury, especially with a pelvic fracture or hematuria.[link.springer.com]
  • The patient did not give history of hematuria as she was primigravida and having lochia rubra and was not sure about the hematuria.[jfmpc.com]
  • […] 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]
  • 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]
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]
  • (Recommendation; Evidence Strength: Grade C) Discussion PFUI is associated with high rates of urethral stricture formation and erectile dysfunction, while only small numbers of men will report urinary incontinence. 125,128 Rates of stricture after PFUI[auanet.org]
  • Impotence was noted in 1/7; no urinary incontinence occurred.[east.org]
Anuria
  • The patient had presented 24 h after sustaining the injury with clinical features of anuria and peritonitis. Emergency surgery was undertaken to save the child.[ijhas.in]
  • Patient with sign and symptoms of anuria, oliguria, hematuria, vague abdominal pain, ascites and impaired renal function during postpartum state or puerperium should be evaluated for urinary bladder injury.[jfmpc.com]
  • […] cloudy urine), impaired wound healing (seepage of urine from repair sites, flank or abdominal mass from pockets of urine, and crepitus from urine seepage into tissues), and impaired renal function (nausea, irritability, edema, hypertension, oliguria, and anuria[medical-dictionary.thefreedictionary.com]
  • Indications for radiologic investigation within 24hrs postop included anuria, urinary leakage from wound, and frank hematuria.[east.org]
Pelvic Pain
  • Sign and Symptoms of Bladder Injury Pelvic fracture: Pelvic pain, pelvic instability, shock, gluteal hematoma, abdominal tenderness.[urology-textbook.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]
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]
  • One (1) uretheral stricture and frequency and dysuria in 1. There were 5 long-term complications out of 14 patients treated by catheter drainage only. Two related to other injuries, 3 related to bladder injury and its management.[east.org]

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]
  • The causes, diagnosis and treatment of SBR are reviewed by the authors.[ajol.info]
  • BACKGROUND: Although surgical principles are well accepted for the treatment of an intraperitoneal or extraperitoneal rupture of the urinary bladder, the type and number of drainage catheters needed to obtain a satisfactory outcome with minimal patient[ncbi.nlm.nih.gov]
  • 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 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]

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

  • The etiological investigation revealed a locally advanced and metastatic prostate cancer. The evolution was rapidly fatal and the patient’s death occurred two months later due to metastatic disease.[ajol.info]
  • 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]
  • 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]
  • Background and Epidemiology Trauma refers to injury caused by external force from a variety of mechanisms, including traffic- or transportation-related injuries, falls, assault (e.g., blunt weapon, stabbing, gunshot), explosions, etc.[auanet.org]
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]
  • Thus emptying of urinary bladder before delivery, postpartum and in puerperal state is to be encouraged strictly to prevent bladder wall rupture.[jfmpc.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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