Presentation
History of fall from staircase. Inability to pass urine. No evidence of external injuries.
Patient Data
Visceral organs appear normal. Massive ascites. CT cystogram revealed the defect in the bladder wall resulting in extravasation of contrast. Extravasation of contrast between bowel loops, mesenteric folds and paracolic gutters typical for intraperitoneal rupture of bladder.
Retrograde cystogram is the initial investigation to be performed in case of pelvic injuries to rule out urethral injuries, then followed by CT cystogram to detect bladder rupture. CT IV contrast study is done after to rule out any other active extravasation.
Case Discussion
Despite normal appearing visceral organs, the patient presented with massive ascites. After correlation with the history, CT cystogram was performed which revealed intraperitoneal bladder rupture. Retrograde urethrogram should be considered prior to CT cystogram to eliminate urethral rupture, since catheterization is contraindicated in the latter.
CT cystogram is essential to diagnose intra- or extraperitoneal rupture of bladder, it can occur before or after an IV enhanced study depending on the clinical need. At least 300 mL of contrast is necessary to detect small defects in the bladder wall.
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