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RUPTURE
OF THE BLADDER
Extraperitoneal rupture
Extraperitoneal rupture is most commonly associated with fracture
of the pelvis, resulting in extravasation of urine (Figure
6.61). The patient may pass only small drops of blood when
attempting to pass urine. A significant feature is swollen
soft tissues of the groin extending to the scrotum, due to
extravasated urine.
Intraperitoneal rupture
Intraperitoneal rupture is often the result of a direct blow
to the bladder or a sudden deceleration of the patient when
the bladder is distended, for example in a road traffic accident
(Figure 6.62). Intraperitoneal rupture presents as “acute
abdomen”, with pain in the lower abdomen, tenderness
and guarding associated with failure to pass urine.
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If
possible, urgently refer patients with rupture of the
bladder to a surgical specialist |
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For
extraperitoneal rupture, construct a suprapubic cystostomy;
if the rupture is large, also place a latex drain
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For
intraperitoneal rupture, close the rupture and drain
the bladder with a large urethral catheter or a suprapubic
drain; if the rupture is large, also place a latex drain |
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Evaluate
your patient carefully to ensure that other injuries
are not missed. A ruptured bladder is an indication for
a full trauma laparotomy to rule out other abdominal
injuries. |
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Bladder rupture, usually due to trauma,
can be extraperitoneal or intraperitoneal
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Extraperitoneal rupture is most commonly associated with
fracture of the pelvis
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Intraperitoneal
rupture is often the result of a direct blow to the bladder
or a sudden deceleration.
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