URINARY B ADDE L R INJURY By DHANUSH ANAND ROLL NO : 21
BLADDER INJURY∗ Traumatic injury of the bladder and urethra involves damage caused by an outside force.∗ Traumatic injury to the bladder is uncommon. Only 8 - 10% of pelvic fractures lead to bladder injury.∗ Injury may occur if there is a blow to the pelvis severe enough to break the bones & cause bone fragments to penetrate the bladder wall.
Causes of bladder injury∗ Road traffic accidents∗ Blow,kick or fall∗ Stabs,gunshot injuries∗ Endoscopic trauma∗ Diathermy∗ Instrumentations eg. During hysterectomy,herniotomy, excision of rectum,LSCS etc
Mechanism of bladder injuryPerforation of bladder dome duringVeress needle/trocar insertionIncidental cystotomy duringdevelopment of bladder flap & VVS in routine/radical Hysterectomy
INTRAPERITONEAL RUPTURE∗ Occurs in 20% of bladder rupture cases∗ Occurs due to blow, kick or fall∗ Blunt trauma more likely to result in intraperitoneal rupture in children than adults;∗ Since the pediatric bladder is more intraperitoneal∗ The adult bladder dome remains mostly extraperitoneal∗ Blunt trauma in an adult can result in intraperitoneal rupture only if the bladder is fully distended bladder
CLINICAL F AT E URES∗Sudden pain in suprapubic region∗Shock & syncope∗Diffuse abdominal pain∗Abdominal distention∗Lately results in peritonitis, with guarding rigidity ,rebound tenderness.∗Patient does not have the desire to micturate
MANAGE E M NT(A)INVESTIGATIONS∗ Plain x-ray shows ground glass appearance∗ Presence of urine is confirmed by peritoneal tap∗ Retrograde cystography∗ CT scan abdomen∗ Ultra sonography
(B)TREATMENT The goals of treatment are to:∗Control symptoms∗Repair the injury∗Prevent complications
∗ INJURY REPAIR∗ Emergency laprotomy is th only treatment for intraperitoneal rupture∗ Bladder tear is sutured in two layers using vicryl ,peritoneal wash is given∗ Malecot’s catheter is placed from above as SPC∗ Prevesical space & peritoneal cavity are drained separately∗ Foley’s catheter from below is also passed∗ Antibiotics is given to prevent sepsis
EXTRAPERITONEAL BLADDER RUP TURE∗ Extraperitoneal rupture is the most common type∗ Occurs in 80% of bladder rupture cases∗ Extraperitoneal bladder rupture occurs secondary to adjacent pelvic fracture or an avulsion tear at fixation points of puboprostatic ligaments∗ It occurs commonly in a Non Distended Bladder; such as in road Bladder traffic accidents.
CLINICAL F AT E URES∗ Collection of urine& blood in the extraperitoneal space in front∗ Abdominal fullness∗ suprapubic tenderness & pain∗ Scrotal swelling∗ Strangury & inability to micturate∗ Often associated with shock & other injuries
MANAGEMENT(A) INVESTIGATIONS∗Plain x-ray shows fractured pelvis∗Cystogram shows leak from the bladder
TREATMENTThe bladder is exposed extraperotoneally;the tear is identified & sutured.Extraperitoneaal space is irrigated with normal salineBladder is closed with a SPC using malecot’s catheter & a drain is placed in prevesical spaceIf there is any urethral injury it should also be treated
COMPLICATIONS OF BLADDER INJURY∗ Cystitis & pyelonephritis∗ Peritonitis∗ Pelvic abscess∗ Vesiculovaginal or retrovesical fistula∗ Paralytic ileus∗ Haemorrhage∗ Mortality is 100% without surgical intervention
RE E NCE F RE∗ SRB’S manual of surgery∗ Bailey & love’s short prcactise of surgery∗ PUB MED . COM