Isolated intraperitoneal bladder rupture following minor trauma after alcohol ingestion.Abstract: The authors describe a case of intraperitoneal bladder rupture in a 41-year-old male caused by trauma from a fall after alcohol ingestion. The patient presented on the day following the fall with signs of acute urinary retention, and 500 mL of urine was drained after catheterization catheterization Threading of a flexible tube (catheter) through a channel in the body to inject drugs or a contrast medium, measure and record flow and pressures, inspect structures, take samples, diagnose disorders, or clear blockages. . Signs of peritonitis peritonitis (pĕr'ĭtənī`tĭs), acute or chronic inflammation of the peritoneum, the membrane that lines the abdominal cavity and surrounds the internal organs. appeared on the following day, and emergency computed tomography revealed intraperitoneal rupture. Laparotomy revealed a laceration laceration /lac·er·a·tion/ (las?er-a´shun) 1. the act of tearing. 2. a torn, ragged, mangled wound. lac·er·a·tion n. 1. A jagged wound or cut. 2. of the bladder in the fundus fundus /fun·dus/ (fun´dus) pl. fun´di [L.] the bottom or base of anything; the bottom or base of an organ, or the part of a hollow organ farthest from its mouth. . Key Words: alcohol ingestion, bladder rupture, cystography ********** Case Report A 41-year-old male presented to the emergency department with lower abdominal pain and difficulty passing urine. On the previous night, he had a minor fall after a bout of alcohol ingestion. His lower abdomen was tender and distended distended Medtalk Enlarged, bloated. Cf Nondistended. . A working diagnosis of acute urinary retention was made, and 500 mL of blood-tinged urine was drained after catheterization. On the following day, he had signs of peritonitis. An emergency computed tomography (CT) scan revealed free fluid in the peritoneal cavity and extravasation extravasation /ex·trav·a·sa·tion/ (ek-strav?ah-za´shun) 1. a discharge or escape, as of blood, from a vessel into the tissues; blood or other substance so discharged. 2. the process of being extravasated. of contrast around the bladder, signifying intraperitoneal rupture (Figure). A subsequent laparotomy revealed a 6- to 8-cm bladder laceration in the fundus extending posteriorly. The edges were trimmed, and the defect was repaired in two layers. After the surgery, the patient made an uneventful recovery. Discussion Intraperitoneal bladder rupture after minor trauma in intoxicated in·tox·i·cate v. in·tox·i·cat·ed, in·tox·i·cat·ing, in·tox·i·cates v.tr. 1. To stupefy or excite by the action of a chemical substance such as alcohol. 2. patients is an infrequently reported but recognized clinical entity. (1) The condition is characterized by very few signs on initial presentation. Usually, a history of trauma can be obtained. The injury is usually so trivial that it often goes unnoticed. The pathogenesis relates to the full bladder at the time of injury, secondary to alcohol intake. The sudden pressure after a trauma results in rupture usually at the peritoneal peritoneal /peri·to·ne·al/ (per?i-to-ne´al) pertaining to the peritoneum. peritoneal pertaining to the peritoneum. reflection over the fundus, which is the weakest point of the distended bladder. The investigation of choice is plain film cystography. Films should include anteroposterior anteroposterior /an·tero·pos·te·ri·or/ (-pos-ter´e-er) directed from the front toward the back. an·ter·o·pos·te·ri·or adj. Abbr. AP 1. Relating to both front and back. , oblique, or lateral and postdrain view. CT cystography is more ideal in patients undergoing CT for other injuries associated with blunt trauma. (2) [FIGURE OMITTED] Conclusion All intraperitoneal bladder ruptures caused by blunt trauma are best managed by surgical exploration and repair. The most serious complication results from failure to diagnose failure to diagnose, n a failure to assess a patient's condition. Harm may be inflicted by the failure to administer treatment to a potentially treatable condition. and control urine extravasation initially. Delayed intervention can result in intra-abdominal and pelvic abscesses. Therefore, a high degree of clinical suspicion along with timely surgical intervention will greatly reduce the morbidity and improve the outcome in these patients. Accepted November 10, 2004. References 1. Herd AM, Crofts NG, Lee LM, et al. Isolated bladder rupture after minor trauma a in patient with alcohol intoxication. J Emerg Med 1994;12:409-411. 2. Deck AJ, Shaves S, Talner L, et al. Computerised tomography for diagnosis of traumatic bladder rupture. J Urol 2000;164:43-46. RELATED ARTICLE: Key Points * Intraperitoneal bladder rupture after minor trauma in intoxicated patients is an infrequently reported but recognized clinical entity. * The investigation of choice is plain film cystography, which should include anteroposterior, oblique, or lateral and postdrain views; computed tomography scan Computed tomography scan (CT scan) A specialized type of x-ray imaging that uses highly focused and relatively low energy radiation to produce detailed two-dimensional images of soft tissue structures, particularly the brain. cystography is more ideal in patients undergoing computed tomography scan for other injuries associated with blunt trauma. * All intraperitoneal bladder rupture caused by blunt trauma is best managed by surgical exploration and repair; delayed intervention can result in intraabdominal and pelvic abscess. N. Sezhian, FRCS, D. Rimal, MD, and G. Suresh, MS, FRCS From the Surgical Rotation and the Department of Urology, James Paget Healthcare NHS Trust, Norfolk, United Kingdom. Reprint requests to Dr. Debesh Rimal, Flat 15, James Paget NHS Trust, Great Yarmouth, NR31 6LA, United Kingdom. Email: kathmanducity@aol.com |
|
||||||||||||||||||||
Printer friendly
Cite/link
Email
Feedback
Reader Opinion