An Article By

Dr. Ahmed Esawy

MBBS M.Sc MD

Urinary Bladder Trauma

• Is more frequent in blunt injuries.

•Conventional cystography has long been

considered the standard reference for

evaluation of bladder injury, and is

considered more senstive.

•The advance of CT cystography replaces

the conventional cystography in many

centers. It has a diagnostic accuracy

approaching 100 %.

Types of UB Trauma

Fives types of bladder injury are described

Type 1: Contusion

Type 2: Intraperitoneal Rupture

Type 3: Interstitial Injury

Type 4: Extraperitoneal Rupture

Type 5: Combined Rupture

INTRAPERITONEAL

RUPTURE

On a CT cystogram, an intravesical hematoma (arrow)

and a small focus of air introduced during bladder

filling are seen as filling defects.

Interstitial injury

CT cystogram demonstrates focal lenticular thickening of the bladder wall due to

interstitial hematoma and likely muscular disruption (black arrow), even material is seen

delineating the injury. Multiple pelvic fractures are also noted (white arrows)

Simple extraperitoneal

rupture

CT cystogram demonstrates extravasated contrast material confined to the

perivesical space within the extraperitoneal pelvis (arrows). The extravasated

contrast material demonstrates the typical "molar tooth" appearance

Complex

extraperitoneal

rupture

CT cystogram demonstrates extraperitoneal perivesicular

extravasation with the typical molar tooth appearance (solid arrows).

There is extension into the rectus abdominis muscle as well as the

superficial fatty layer (fascia of Camper) and deeper membranous layer

(Scarpa fascia) of the subcutaneous fascia (open arrow).

CT cystograms show diastasis of the pubis symphysis (arrowheads in a)

with disruption of the urogenital diaphragm, which allows contrast material

to extend directly into the deeper membranous subcutaneous fascial

planes and along the scrotal sub-dartos fascia (arrows).

Combined intraperitoneal & extraperitoneal Rupture

free contrast material delineating loops of small bowel, a finding that is characteristic of an intraperitoneal rupture.

contrast material insinuating itself into the perivesical and perirectal spaces of the extraperitoneal pelvis (straight arrows). Pubic rami fractures are also noted (curved arrow).

The arrows point to the presence of acute hematoma with its whorled-like appearance

within the confines of the urinary bladder. Also note the presence of fluid within the

peritoneal cavity compatible with ascites, a mixture of blood and urine.

INTRAPERITONEAL BLADDER RUPTURE WITH HEMATOMA WITHIN CONFINES OF BLADDER

CT cystogram demonstrates the classic appearance of an

intraperitoneal rupture, with extravasated contrast material

between loops of small bowel (arrows) and the anterior

pararenal fascia (arrowheads).

CT cystogram demonstrates

heterogeneous attenuation at the

bladder dome rupture site (arrow).

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