It has been suggested that a fourth mechanism exists wherein pelvic fractures in association with extraperitoneal (EP) bladder rupture are coincidental rather than causative. In one series, only 35% of bladder perforations were noted to have their injuries on the same side as the pelvic fracture.5 A proposed mechanism is that severe lower abdominal selleck chemicals trauma causes
an injury similar to that seen in a full bladder where the collapsed bladder ruptures Inhibitors,research,lifescience,medical from sheer blunt force.6 Complicated bladder lacerations involve the bladder neck and frequently there is disruption of the pelvic floor. This can result in contrast extravasation to the perineum, scrotum, penis, and anterior abdominal Inhibitors,research,lifescience,medical wall (Figure 1). Involvement of the bladder neck is often an extension of an injury. In adults, the laceration is usually a longitudinal split and can be caused by progression of the injury proximally
from a urethral tear or distally from the EP bladder. The involvement of the bladder neck or ureteric orifices converts a simple bladder perforation into one that is complex and requires surgical exploration and repair. Figure 1 Complex bladder neck injury with contrast extravasation into perineum on retrograde urethrogram. Classification Inhibitors,research,lifescience,medical Bladder trauma can be broadly classified as contusions of the bladder wall or intramural hematomas that are self-limiting and require Inhibitors,research,lifescience,medical no specific treatment (Figure 2), EP injuries that occur in 60% of all bladder traumas (Figure 3), intraperitoneal (IP) lacerations that can be seen approximately 25% of the time in patients without pelvic fracture (Figure Inhibitors,research,lifescience,medical 4), and combined IP and EP perforations that occur in 2% to 20% of all injuries.1 Bladder contusion is probably the most common type and is a relatively minor injury that
does not require specific treatment. Radiologic findings are almost L-NAME HCl always normal in these patients with gross hematuria. Two classification systems exist, one based on radiographic appearance (Table 1)7 and the other on injury severity (Table 2).8 Although these classifications may be useful for research purposes, they are of little use clinically and are rarely used in day-to-day practice. In terms of clinical relevance, classification centers on differentiating between EP and IP injury and between simple and complex injury as treatment and outcome may be different. These classifications are based on a combination of radiologic studies and/or findings at laparotomy. Figure 2 Computed tomography image revealing mural irregularity and clot at the dome of the bladder.