Intraperitoneal bladder rupture

Case contributed by Frank Gaillard , 4 Aug 2013
Diagnosis almost certain
Changed by Henry Knipe, 15 Apr 2015
Hidden edits. Some edits not affecting the appearance of this case have been suppressed.

Updates to Study Attributes

Findings was changed:

There is a moderate amount of free fluid within the right upper quadrant and right paracolic gutter, with a small amount of fluid also seen in the left upper quadrant and the mesentery. This fluid is only slightly denser than water / urine, but certainly does not represent merely a haemoperitoneum. The dome of the bladder appear a little thickened and irregular, although the bladder is well distended. This is in keeping with an intra-peritoneal bladder rupture subsequently proven at laparotomy.

There is no liver injury demonstrated. The spleen, pancreas or adrenal glands and kidneys are normal in appearance.  No bowel wall thickening appreciated. Duodenum unremarkable. No lumbar spinal or pelvic fractures. Minor subcutaneous fat stranding in lower anterior abdominal wall, in keeping with seatbelt injury.

Images Changes:

Image CT (C+ portal venous phase) ( update )

Perspective was set to Axial.

Updates to Quizquestion Attributes

Question was added:
What is the main abnormality?
Answer was added:
Large volume of free fluid. Not dense enough to be pure haemoperitoneum.

Updates to Quizquestion Attributes

Question was added:
How suspicious of an occult injury should you be?
Answer was added:
Highly - the patient is male and there is a large volume of free fluid, which should be considered pathological (only a trace of free fluid in the pelvis is acceptable).

Updates to Quizquestion Attributes

Question was added:
List organs which may be injured in this setting.
Answer was added:
Bowel, bladder, bile ducts, solid organs (e.g. liver, spleen).

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