IMAGE OF THE WEEK 2012

WEEK 11

BLADDER RUPTURE

Bladder rupture is uncommon.  It can be divided broadly into intra-peritoneal and extra-peritoneal rupture, the latter being more common, representing at least 80% of all cases.

Bladder rupture is commonly associated with severe pelvic fractures, such as those following high speed RTA’s or other high velocity trauma.

Intra-peritoneal rupture

• Occurs following trauma to the lower abdomen when the bladder is distended
• The bladder dome is the weakest point, so it ruptures most easily
• Contrast extravasation occurs into the paracolic gutters and between loops of small bowel

Extra-peritoneal rupture

• Almost always associated with pelvic fractures
• Usually occurs close to the base of bladder
• Extra-peritoneal bladder rupture generally is secondary to an adjacent pelvic fracture or an avulsion tear at fixation points of pubo-prostatic ligaments.

• It may be further subdivided into:

• Simple - with contrast extravasation limited to peri-vesical space
• Complex - with contrast extravasation extending to thigh, scrotum or perineum.

The diagnosis can be made with either a traditional fluoroscopic cystogram study or with CT cystogram/IVU, the latter being more sensitive.

In this case contrast can be seen to extend beyond the confines of the urinary bladder, into the extra-peritoneal space (Figure 1). The leak, as is often the case, is arising from the bladder base, in close proximity to the disrupted pubic symphysis (Figure 2).  Further contrast extravastation has occurred into the soft tissues of the anterior abdominal wall/groins bilaterally (Figure 3 & 4).  There is an extensive pelvic fracture as is normally the case with extra-peritoneal bladder injuries (Figure 5).

Figure 3: Click on image to enlarge	Figure 4: Click on image to enlarge	Figure 5: Click on image to enlarge

Image and text contributed and prepared by

Dr Ian Bickle, Department of Radiology, RIPAS Hospital, Brunei Darussalam.

All images are copyrighted and property of RIPAS Hospital.