RUPTURED BLADDER

This usually follows a blow, a kick, or a fall on a distended bladder, gunshot or stab wounds, passage of instruments, endoscopic resection of prostate or bladder tumour, diathermy coagulation of bladder tumour, and operative
procedures in the pelvis (for example, tubal ligation and hysterectomy).

Clinical Features

  • The bladder may be injured intraperitoneally or extraperitoneally. Intrapentoneal rupture results in sudden agonizing pain in the hypogastrium, severe shock, with a rigid abdomen that distends slowly. The patient passes no urine. Rectal examination reveals a bulge in the pouch of Douglas. Extraperitoneal rupture
    displays similar symptoms as in rupture of posterior urethra described above.
  • The patient experiences pain, has blood stained urine, and may show other features of the primary pathology.
  • Severe peritonitis is an ominous complication that may develop if the patient is not attended to within 12 hours. In situations of delayed attention, it may have a mortality rate of 100%.

Investigations

  • Plain erect radiograph of the abdomen may show ground glass appearance of fluid in the lower abdomen.
  • Intravenous urography will demonstrate a leak from the bladder.

Management

  • Initiate resuscitation measures.
  • If there is no fracture of the pelvis, pass a 14F Foley’s catheter and a little blood stained urine may drain out.
  • If not sure of diagnosis  make immediate referral to higher level for appropriate management.
  • Conduct laparotomy after resuscitative measures are taken.
  • Repair the rupture in the bladder in two layers.
  • Leave a urethral catheter in situ for 10–14 days.