URINARY BLADDER INJURY

By DHANUSH ANAND

ROLL NO : 21

Traumatic injury of the bladder and urethra involves damage caused by an outside force.

Traumatic injury to the bladder is uncommon. Only 8 - 10% of pelvic fractures lead to bladder injury.

Injury may occur if there is a blow to the pelvis severe enough to break the bones & cause bone fragments to penetrate the bladder wall.

BLADDER INJURYBLADDER INJURY

Road traffic accidents Blow,kick or fall Stabs,gunshot injuries Endoscopic trauma Diathermy Instrumentations eg. During

hysterectomy,herniotomy, excision of rectum,LSCS etc

Causes of bladder injury

Mechanism of bladder injury

Perforation of bladder dome during Veress needle/trocar insertion

Incidental cystotomy during development of bladder flap & VVS in routine/radical Hysterectomy

Occurs in 20% of bladder rupture cases Occurs due to blow, kick or fall Blunt trauma more likely to result in intraperitoneal

rupture in children than adults; Since the pediatric bladder is more intraperitoneal

The adult bladder dome remains mostly extraperitoneal

Blunt trauma in an adult can result in intraperitoneal rupture only if the bladder is fully distended fully distended bladderbladder

INTRAPERITONEAL INTRAPERITONEAL RUPTURERUPTURE

Sudden pain in suprapubic regionShock & syncopeDiffuse abdominal painAbdominal distentionLately results in peritonitis, with guarding rigidity , rebound tenderness.Patient does not have the desire to micturate

CLINICAL FEATURESCLINICAL FEATURES

(A)INVESTIGATIONS

Plain x-ray shows ground glass appearance Presence of urine is confirmed by peritoneal

tap Retrograde cystography CT scan abdomen Ultra sonography

MANAGEMENT

cystogram

The goals of treatment are to:

Control symptomsRepair the injuryPrevent complications

(B)TREATMENT(B)TREATMENT

INJURY REPAIR

Emergency laprotomy is th only treatment for intraperitoneal rupture

Bladder tear is sutured in two layers using vicryl ,peritoneal wash is given

Malecot’s catheter is placed from above as SPC Prevesical space & peritoneal cavity are drained

separately Foley’s catheter from below is also passed Antibiotics is given to prevent sepsis

Extraperitoneal rupture is the most common type Occurs in 80% of bladder rupture cases

Extraperitoneal bladder rupture occurs secondary to adjacent pelvic fracture or an avulsion tear at fixation points of puboprostatic ligaments

It occurs commonly in a Non Distended BladderNon Distended Bladder; such as in road traffic accidents.

EXTRAPERITONEAL EXTRAPERITONEAL BLADDER RUPTURE BLADDER RUPTURE

Collection of urine& blood in the extraperitoneal space in front

Abdominal fullness suprapubic tenderness & pain Scrotal swelling Strangury & inability to micturate Often associated with shock & other injuries

CLINICAL FEATURESCLINICAL FEATURES

(A) INVESTIGATIONS

Plain x-ray shows fractured pelvisCystogram shows leak from the bladder

MANAGEMENTMANAGEMENT

The bladder is exposed extraperotoneally;the tear is identified & sutured.

Extraperitoneaal space is irrigated with normal saline

Bladder is closed with a SPC using malecot’s catheter & a drain is placed in prevesical space

If there is any urethral injury it should also be treated

TREATMENTTREATMENT

Cystitis & pyelonephritis Peritonitis Pelvic abscess Vesiculovaginal or retrovesical fistula Paralytic ileus Haemorrhage Mortality is 100% without surgical

intervention

COMPLICATIONS OF COMPLICATIONS OF BLADDER INJURYBLADDER INJURY

SRB’S manual of surgery Bailey & love’s short prcactise of surgery PUB MED . COM

REFERENCEREFERENCE