Bladder rupture: Experience in 48 cases

Abstract

Bladder rupture is an uncommon injury, but it usually implies significant associated morbidity and mortality. In this study, the clinical, radiological and surgical findings of 48 cases managed for their bladder rupture were evaluated. While the etiologic factors of the ruptures were owing to motor vehicle accidents in 75% of cases, there were 45 non-penetrating, 3 penetrating injuries. Bladder ruptures were demonstrated by retrograde cystography or intravenous pyelography in 45 cases. Remaining 3 cases underwent emergent exploration without radiological investigation. Extraperitoneal, intraperitoneal and combined intraperitoneal and extraperitoneal ruptures were noted in 58.3%, 33.3% and 8.3% of the cases respectively. Associated pelvic fractures were also present in 93%, 18.8% and 100% of cases with extraperitoneal, intraperitoneal, and combined ruptures respectively. while 2 patients with a small extraperitoneal rupture were treated with urethral catheter drainage only, 46 of the patients were treated surgically. Associated organ injuries were present in 42% of the cases and 5 (10.4%) of them were died. In conclusion, the presence of urologic injury must be considered in cases with severe lower abdominal trauma and in all patients with pelvic fracture. The most accurate diagnostic technique for bladder rupture is retrograde cystography. Deaths frequently occur owing to associated organ injuries in patients with bladder rupture.