Extraperitoneal Bladder Rupture

History: 25 year old male presents to the emergency room after a fight at a local bar

Axial CT of the pelvis with intravenous contrast demonstrates a contracted bladder (Y-shaped structure indicated by yellow arrow) with surround free fluid in the pelvis.

Sagittal CT cystogram demonstrates bladder rupture, with contrast confined to an extraperitoneal location (yellow arrow). A foley catheter is seen within the bladder, which was used to inject contrast for this CT cystogram.

This is a case example of extraperitoneal bladder rupture. In the setting of trauma to the bladder it is important to differentiate extraperitoneal from intraperitoneal rupture. Intraperitoneal bladder rupture has to be repaired surgically, whereas extraperitoneal rupture can be treated conservatively with continuous drainage via foley catheter. Bladder rupture can also be classified into the following types:

Type 1: Bladder contusion

Type 2: Intraperitoneal rupture

Type 3: Interstitial injury

Type 4A: Simple extraperitoneal rupture

Type 4B: Complex extraperitoneal rupture (as indicated by extension beyond the perivesical space into the thigh, scrotum, abdominal wall, or retroperitoneum).

Type 5: Combined injury.

In the setting of extraperitoneal rupture that demonstrates persistent bleeding, passage of large clots, or bladder neck injury, foley catheter drainage will not be sufficient and surgical management is still necessary.

References:

Bodner, DR. Evaluation and treatment of bladder rupture. http://www.ncbi.nlm.nih.gov/pubmed/7597354