A 76 yo female presents after a fall down several stairs.  She is diagnosed with b/l pubic rami fractures on x-ray.  The patient has difficulty with urination.  A foley is placed and there is blood return.  A CT cystogram is shown.  What's the diagnosis?  Scroll down for answer.

Diagnosis:  Bladder injury (extraperitoneal)

• Occurs with direct blunt trauma to distended bladder
• 70-97% associated with pelvic fractures

• Clinically, patient will have gross hematuria, lower abdominal tenderness, perineal or scrotal edema, difficulty voiding
• Gold standard diagnosis: retrograde cystogram (either x-ray or CT)
• Can be missed on routine CT or US
• Intraperitoneal rupture: contrast matiereal leaks into peritoneal cavity
• Require surgical repair
• Extraperitoneal rupture: contrast material leaks into retroperitoneum
• Most common
• usually managed conservatively and heal within 2 weeks

References

Gratton MC, French L. Genitourinary Trauma. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds.Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8eNew York, NY: McGraw-Hill; 2016.