10/17/2016

Urinarybladderrupture|RadiologyReferenceArticle|Radiopaedia.org

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Urinarybladderrupture
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Urinarybladderrupture|RadiologyReferenceArticle|Radiopaedia.org

Radswikietal.
Urinarybladderruptureisusuallyseeninthecontextofsignificanttrauma.

Onthispage:
Classification
Radiographicfeatures
Treatmentandprognosis
Seealso
References
CasesandFigures
Classification
Bladderrupturecanbecategorizedintofivetypesdependingonthelocationandextentoftherupture.
Bladdercontusion
Thisiscommonlyseenbutsometimesnotclassedastruerupture,sinceitinvolvesanincompletetearofthe
mucosa.
Subserosalrupture
Alsoknownasinterstitialrupture,thisisrare.Itiscausedbyatearintheserosalsurface.
Intraperitonealbladderrupture
Occursinapproximately~15%(range1020%)ofmajorbladderinjuries,andtypicallyistheresultofadirect
blowtothealreadydistendedbladder.Cystographydemonstratesintraperitonealcontrastmaterialaroundbowel
loops,betweenmesentericfoldsandintheparacolicgutters.Treatmentissurgicalrepair.
Extraperitonealbladderrupture
Extraperitonealruptureisthemostcommontypeofbladderinjury,accountingfor~85%(range8090%)of
cases.Itisusuallytheresultofpelvicfracturesorpenetratingtrauma.Cystographyrevealsavariablepathof
extravasatedcontrastmaterial.Treatmentiswithanindwellingcatheter(IDC/Foley).
Combinedbladderrupture
Simultaneousintraperitonealandextraperitonealinjury.Cystographyusuallydemonstratesextravasation
patternsthataretypicalforbothtypesofinjury.
Radiographicfeatures
Traditionalinvestigationforsuspectedbladderrupturewithwascarriedoutwithfluoroscopiccystography3.
However,asthisistimeconsumingandcannotcharacteriseotherpelvicstructuresitsuseisbeinggradually
supersededbyCTcystography.
CT

CTcystographyisperformedbyinstillingwatersolublecontrastintothebladderthroughaFoleycatheter.It
maybecombinedwithstandardCTtoevaluatetheuppertracts.
Appearancesvarywiththesiteofinjury:
bladdertrauma
normal
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subserosalrupture
elipticalextravasationofcontrastaroundthebladder
intraperitoneal
usuallybladderdomerupture
contrastinparacolicguttersandbetweenloopsofsmallbowel
extraperitoneal
usuallyatbladderbaseanterolaterally
extraluminalcontrastintoperivesicalspace(simple)
molartoothsign
extensionofextraluminalcontrasttothigh,scrotumorperineum(complex)
combined
mixedfeaturesofintraperitonealandextraperitonealrupture
Treatmentandprognosis
Intraperitonealrupturerequiressurgicalrepairwhileextraperitonealinjuriesaretreatedconservativelywitha
bladdercatheter.Thepresenceofotherrenaltractinjuriesinvolvingtheuretersorurethramayrequireseparate
intervention.
Seealso
cystography
CTcystography

References
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URLofArticle https://radiopaedia.org/articles/urinarybladderrupture

ArticleInformation
rID:12756
Systems:Urogenital,Trauma
Section:Pathology
Tags:bladder,trauma,urology,corecondition
SynonymsorAlternateSpellings:
Intraperitonealbladderrupture
Extraperitonealbladderrupture
Ruptureofurinarybladder
Bladderrupture
Intraperitonealurinarybladderrupture
Extraperitonealurinarybladderrupture
Bladderinjury

CasesandFigures

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Case1:intraperitonealruptureonultrasoundCase1:intraperitonealruptureonultrasound
Dragheretoreorder.

Case2:intraperitonealruptureCase2:intraperitonealrupture
Dragheretoreorder.

Case3Case3
Dragheretoreorder.

Case4Case4
Dragheretoreorder.
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Case5:intraperitonealruptureCase5:intraperitonealrupture
Dragheretoreorder.

Case6:extraperitonealbladderruptureCase6:extraperitonealbladderrupture
Dragheretoreorder.

Case7:extraperitonealruptureCase7:extraperitonealrupture
Dragheretoreorder.

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Case8:intraperitonealbladderruptureCase8:intraperitonealbladderrupture
Dragheretoreorder.

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