Date post: | 11-Jun-2015 |
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URINARY BLADDER INJURY
By DHANUSH ANAND
ROLL NO : 21
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.
BLADDER INJURYBLADDER INJURY
Road traffic accidents Blow,kick or fall Stabs,gunshot injuries Endoscopic trauma Diathermy Instrumentations eg. During
hysterectomy,herniotomy, excision of rectum,LSCS etc
Causes of bladder injury
Mechanism of bladder injury
Perforation of bladder dome during Veress needle/trocar insertion
Incidental cystotomy during development of bladder flap & VVS in routine/radical Hysterectomy
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 fully distended bladderbladder
INTRAPERITONEAL INTRAPERITONEAL RUPTURERUPTURE
Sudden pain in suprapubic regionShock & syncopeDiffuse abdominal painAbdominal distentionLately results in peritonitis, with guarding rigidity , rebound tenderness.Patient does not have the desire to micturate
CLINICAL FEATURESCLINICAL FEATURES
(A)INVESTIGATIONS
Plain x-ray shows ground glass appearance Presence of urine is confirmed by peritoneal
tap Retrograde cystography CT scan abdomen Ultra sonography
MANAGEMENT
cystogram
The goals of treatment are to:
Control symptomsRepair the injuryPrevent complications
(B)TREATMENT(B)TREATMENT
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 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 BladderNon Distended Bladder; such as in road traffic accidents.
EXTRAPERITONEAL EXTRAPERITONEAL BLADDER RUPTURE BLADDER RUPTURE
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
CLINICAL FEATURESCLINICAL FEATURES
(A) INVESTIGATIONS
Plain x-ray shows fractured pelvisCystogram shows leak from the bladder
MANAGEMENTMANAGEMENT
The bladder is exposed extraperotoneally;the tear is identified & sutured.
Extraperitoneaal space is irrigated with normal saline
Bladder is closed with a SPC using malecot’s catheter & a drain is placed in prevesical space
If there is any urethral injury it should also be treated
TREATMENTTREATMENT
Cystitis & pyelonephritis Peritonitis Pelvic abscess Vesiculovaginal or retrovesical fistula Paralytic ileus Haemorrhage Mortality is 100% without surgical
intervention
COMPLICATIONS OF COMPLICATIONS OF BLADDER INJURYBLADDER INJURY
SRB’S manual of surgery Bailey & love’s short prcactise of surgery PUB MED . COM
REFERENCEREFERENCE