Monday, August 24, 2009

Traumatic Bladder Rupture

This was an interesting scenario. Little old lady falls down a week prior to presentation. She develops progressively worsening abdominal pain. She notes her urine is bloody. One day, her son is visiting and she gets dizzy and collapses. He brings her in to the hospital.

When I see her, her entire lower abdominal wall is erythematous and indurated. She's frankly septic and in acute renal failure. Because of the fall mechanism, we sent her for a CT cystogram (contrast infused via the foley catheter). The images above demonstrate an impressive extraperitoneal bladder rupture with extravasation extending along the anterior abdominal wall.

Given the severity of the injury, I took her to the OR. A liter or so of urine was found marinating the subcutaneous fat and fascia of the lower abdominal wall. Non viable tissue was sharply debrided and I lavaged the resultant gaping wound. Primary repair of the defect proved difficult because of how long she had gone untreated, so I just patched the sinus tract with alloderm and put a Wound Vac on the shark bite surgical site to facillitate healing and wound care. She'll have a foley catheter for decompression for quite a while....


rlbates said...

That must have been a hell of a fall! Amazing

radinc said...

c'mon buckeye your clinical skills are top notch but come clean, did you really go from presentation to ct cysto?

or maybe you guys got a regular ct a/p first which showed craziness in the anterior abdominal wall? or how about plain films that showed a pelvic fx? and one of those lead to the ct cysto, right?


Jeffrey Parks MD FACS said...

Patient a transfer in from outside facility. 1st scan of A/P showed "craziness". Hence the Ct cystogram.

Anonymous said...

Good case but sounds expensive, couldn't you have tried the Blue Pill first???

Joseph Sucher, MD FACS said...

I walked on rounds with Dr. James "Red" Duke for 5 years. He has been practicing for some 50 years and everyday he would say "I've never seen that before" (you must say that in your mind with a thick cowboy accent).