True about extraperitoneal urinary bladder rupture is all except
Ans. c (Commonly associated with anterior urethral rupture). (Ref. LB, 25th/ 1365)Rupture of the bladder may be -# Intraperitoneal (20 per cent) or - Extraperitoneal (80 per cent).Extraperitoneal bladder rupture (JIPMER 2003)# It is commonest type of bladder rupture (80%) after blunt trauma abdomen & is associated usually with bony pelvis & posterior urethral injuries.# The urine extravasates in perivesical region, first in cave of Ritzius i.e., retropubic space.# Radiograph may show pelvic bones, pear shaped bladder density, loss of obturation fat planes, upward displacement of coils & paralytic ileus.# Cystography (gold standard, definitive) reveals distorted bladder with extravasation of contrast in perivesical space & streaks of contrast into facial planes giving typical "sun burst" appearance.# US shows "bladder in bladder" appearance due to perivesical collection and rent may be detected.# CT cystography is best investigative technique as the exact site & extent of rent, bladder wall contusions, blood clots & surrounding organ injuries can be detected.# Can be managed conservatively without surgical intervention.Intraperitoneal rupture# Intraperitoneal rupture may be secondary to a blow, kick or fall on a fully distended bladder and it is more common in the male than in the female, and usually follows a bout of beer drinking. More rarely, it is due to surgical damage. Extraperitoneal rupture is usually caused by a fractured pelvis or is secondary to major trauma or surgical damage.# Treatment of intraperitoneal ruptureThe mainstay is to provide adequate drainage of the bladder. The standard treatment is to perform a lower midline laparotomy, urine is removed by suction, after which the patient is placed in Trendelenberg's position. The edges of the rent, which are usually situated in the posterior part of the dome of the bladder, are trimmed and sutured with two layers of interrupted catgut stitches, and the operation completed by placement of a suprapubic and urethral catheter.The peritoneum should be irrigated with copious amounts of warm saline.Operations in which the bladder is liable to be injured are:# Inguinal or femoral herniotomy;# Hysterectomy by either the abdominal or vaginal route; and# Excision of the rectum. In the latter two operations, the bladder should be catheterised prior to operation to minimize the risks of this accident.If the injury is recognised at the time, the bladder must be repaired in two layers and urethral catheter drainage maintained for 7 days. If it is not recognised, the treatment is similar to that of rupture of the bladder.When accidental perforation of the bladder occurs during endoscopic resection of a bladder tumour, or the prostatic capsule is perforated during transurethral prostatectomy, the perforation is usually extraperitoneal.
Associated with fracture pelvis in about 70% cases
More common than intraperitoneal bladder rupture
Commonly associated with anterior urethral rupture
Can be managed conservatively without surgical intervention
Urinary Bladder