A series of unfortunate bladder events: An illustrative case series of a diverse cohort of bladder perforations

Abstract

Bladder perforation is a potentially life-threatening condition, typically occurring after genitourinary trauma. The vast majority of cases are secondary to blunt abdominal trauma resulting in pelvic fractures, with motor vehicle accidents the commonest cause. There are however a wide range of underlying causes, including iatrogenic injuries and spontaneous perforations. This case series of 4 unusual cases of bladder perforations presenting to a single center under the same consultant within a 3-month period aims to highlight the diverse nature of patients who can present with bladder perforations and the different management options available.

Keywords: Bladder injury; Bladder perforation; Extraperitoneal; Intraperitoneal; Trauma.

Fig. 1

Case 1—Extraperitoneal bladder perforation: Axial (A) and coronal (B) images of a CT urogram demonstrating contrast extravasation (circle) and pooling in the extraperitoneal space with associated inflammation as well as a large collection of contrast within the scrotum (arrow). Postoperative images from a CT cystogram (images D and E) show no residual extravasation. A preoperative pelvic X-ray (C) demonstrates a pelvic fracture (cross) stabilized with a pelvic binder (star). A postoperative pelvic X-ray (F) illustrates the pelvic fracture repair (star and cross).

Fig. 2

Case 2—Iatrogenic intraperitoneal bladder perforation: Coronal (A) and sagittal (B) images from a CT urogram demonstrating contrast extravasation (arrows) with a large volume of intraperitoneal-free fluid (crosses) and a thickened postpartum uterus (star). Anterior-posterior (C) and lateral (D) images of a retrograde stress cystogram confirming no residual urine leak following conservative management with an indwelling urethral catheter.

Fig. 3

Case 3—Spontaneous intraperitoneal bladder perforation: Axial (A), coronal (B), and sagittal (C) images of a CT urogram. Active contrast extravasation can be seen (circles) with a large volume of intraperitoneal fluid (crosses). Bladder stones (arrows) can be seen within the augmented bladder with a suprapubic catheter (star) in situ.

Fig. 4

Case 4—Intraperitoneal bladder perforation following a minor fall: Axial (A), coronal (B), and sagittal (C) images from a CT cystogram demonstrating active contrast extravasation (arrows) with a large volume of clot (stars) within the bladder and a urethral catheter (cross) in situ.