History: 25 year old male presents to the emergency room after a fight at a local bar
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.
Bodner, DR. Evaluation and treatment of bladder rupture. http://www.ncbi.nlm.nih.gov/pubmed/7597354